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Stefan J Lang, Mona Bischoff, Daniel Böhringer, Berthold Seitz, Thomas Reinhard; Analysis of the changes in keratoplasty indications. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3143.
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Recently, novel techniques were introduced to the field of corneal surgery. I.e. the descemet membrane endothelial keratoplasty (DMEK) and corneal crosslinking damatically changed the therapeutic approaches in Fuchs endothelial dystrophy and keratoconus, respectively. We herein investigate whether these techniques have any impact on the volume and spectrum of keratoplasties in a center more specialized in treating Fuchs dystrophy (centre 1) and a second center that is more specialized in treating keratoconus (centre 2).
We retrospectively reviewed the waiting lists for indication, transplantation technique and the patients' travel distances to the hospital at both centres. The records started in 2003 (center 1) and 2009 (center 2). All data until October 2013 were included.
We reviewed a total of 3544 procedures. The total number increased from 411 in 2009 to 498 in 2013. Fuchs dystrophy increased at centre 1 from 17% to 42% and from 24% to 32% at centre 2. In centre 1, the overall share of DMEK increased from zero percent in 2010 to 49% (144) in 2013. In centre 2, DMEK was not performed until 2013. The percentage of patients with keratokonus slighthly decreased from 15% in 2009 vs. 14% in 2013 in centre 1. The respective percentages in centre 2 were 47% and 18%. In both centers, the patients' travel distances increased. This increase was more pronounced in centre 1 where the mean airplane distance from the patients' homes to the hospital increased from 55 miles in 2003 to 146 miles in 2013 (centre 2: 65 miles in 2009 to 80 miles in 2013).
The results from centre 1 show that DMEK increases the number of keratoplasties. The increase in travel distance suggests that this cannot be fully attributed to recruiting the less advanced patients from the hospital proximity. The increase is rather due to more referrals from other regions. The decrease of keratokonus patients in both centres is surprising and may be attributed to corneal crosslinking.
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