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Oualid Guechi, Lhuillier Louis, Cedric Ghetemme, Anne-Laure Jeancolas, Adina Agapie, Francois Ameloot, Shanour Premy, Jean-Marc Perone; Evolution of indications and surgical techniques of corneal graft: retrospective study about 501 grafts.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5454.
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© ARVO (1962-2015); The Authors (2016-present)
These last 10 years, the corneal graft knew considerable technical innovations with the development of lamellar keratoplasty. In this study, we analyze the evolution of indications and techniques used for 501 consecutive corneal grafts realized since January 2000.
The study is retrospective, monocentric, and concerns corneal grafts realized from January 2000 to November 2013. The database used is the french waiting list management software called: GLAC. We analysed the transplants indications and the used surgical technique.
A total of 501 grafts were listed between January 2000 and November 2013. The main indications over this period were: pseudophakic bullous keratopathy (34.9 %), keratoconus (16.2 %), previous grafts failure (14.2 %), primary corneal endotheliopathy (Fuchs dystrophy mainly) (9.4 %), traumatic keratitis (5.6 %), viral keratitis 4.6 %), stromal dystrophy (3.8 %), bacterial keratitis(3.6 %) and parasitic keratitis (1.2 %). The distribution of grafts indications underwent few variations these last ten years, except recently for the cases of endothelial dystrophy. Proportion of endothelial keratoplasty (DSAEK and DMEK) is mostly increasing lasts years and is representing 31 % of all the keratoplasty in 2012 and 42 % in 2013
The decrease of indications of penetrating keratoplasty (KT) is the consequence of the development last 10 years of various techniques of lamellar keratoplasty: deep anterior lamellar keratoplasty (DALK) for keratoconus and anterior stromal dystrophy, and posterior lamellar keratoplasty for the endothelial dysfunction (DSAEK Descemet's Stripping automated Endothelial keratoplasty and DMEK). The advent of lamellar keratoplasty in the middle of 2000s changed profoundly our practices of corneal graft, both in the operating indication and also on the performed surgical techniques. Lamellar keratoplasty are majority today and the main indications are primitive or secondary endothelial dysfunction and advanced keratoconus.
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