Current Indications and Surgical Approaches to Corneal Transplants at the Kensington Eye Institute, University of Toronto: A Clinical-Pathological Study

Abstract

Purpose : To determine the most common reasons and surgical approaches for corneal graft surgery at the Kensington Eye Institute (KEI), University of Toronto (U of T).

Methods : Following institutional REB, all consecutive cases of corneal transplant surgery at KEI in 2012 and 2013 were reviewed. Demographic, clinical and pathological records of adult corneal transplants were collected from the date of the first corneal transplant surgery at KEI, November 6^th, 2012, to December 31^st, 2013. Data was obtained from the U of T Ophthalmic Pathology Laboratory. All clinical diagnoses and pathological reports were used to categorizethe type of procedure performed. Full-thickness transplants were distinguished from partial-thickness transplants which were further categorized as DSAEK, DMEK, or DALK. Each procedure type was assessed according to their disease indications, age and gender, and pathological findings.

Results : The mean age for corneal transplants was 64 ± 17 years. 49% were full-thickness penetrating keratoplasties (PK) and 51% were partial-thickness. Graft failure (27%), keratoconus (18%), and infection (17%) were the leading indications for PK. Fuchs’ dystrophy (39%), bullous keratopathy (22%), and keratoconus (11%) were main causes for partial-thickness procedures. Among partial-thickness approaches, Descemet’s stripping automated endothelial keratoplasty (DSAEK), Deep anterior lamellar keratoplasty (DALK), & Descemet’s membrane endothelial keratoplasty (DMEK) procedures accounted for 64%, 20%, and 16%, respectively. Fuchs’ dystrophy (40%) and bullous keratopathy (32%) were the most common indications for DSAEK. Keratoconus (57%) and corneal scarring (33%) were the leading indications for DALK, while Fuchs’ dystrophy (84%) accounted for most DMEK procedures. The most common reasons for all corneal grafts were Fuchs’ dystrophy (21%), graft failure (18%), bullous keratopathy (18%), and keratoconus (14%).

Conclusions : Approximately 50% of all corneal transplant procedures at the University of Toronto are partial thickness procedures. A failed graft was the most common indication for full-thickness transplants. Fuchs’ dystrophy was the most common indication for a partial-thickness approach, most often by DSAEK. Longitudinal data is needed to determine whether partial-thickness surgeries will improve graft survival and reduce the need for re-graft.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.