Abstract
Purpose :
To report evolving indications and techniques of corneal transplantation in countries outside of the United States.
Methods :
This was a retrospective database review analyzing publicly available annual reports from the Eye Bank Association of America (EBAA) from 2011-2020. These reports included data on the percentage of tissue exported outside the US from 1991 to 2020, types of procedures from 2011 to 2020, and indications for corneal transplantations from 2017 to 2020. The Cochran-Armitage test was used to assess evolving trends in keratoplasty procedure volumes and indications during these time periods.
Results :
The percentage of corneal tissue exported outside of the US increased from 9% in 1991 to 34% in 2020 (p<0.001). Outside of North America, Asia has received the most transplanted corneas from USA member EBAA Eye Banks, accounting for 15% of all transplanted corneas from 2017 to 2020, followed by Africa (11%), Europe (3%) and South America (2%). Penetrating keratoplasty (PK) decreased from 85% of total international corneal transplants in 2011 to 68% in 2020 (p<0.001), while the proportion of endothelial keratoplasty (EK) increased from 10% in 2011 to 27% in 2020 (p<0.001). Anterior lamellar keratoplasty (ALK) volume was low in comparison, decreasing from 4.9% in 2011 to 4.0% in 2020. From 2017-2020, indication data were reported on corneas exported from the US. Ectasias/thinning was the most common indication for PK, followed by repeat corneal transplant and post-cataract surgery corneal edema. Post-cataract surgery corneal edema was the most common indication for EK, followed by endothelial dystrophies. Surgical indications were unknown for 65% of PK and 30% of EK procedures since 2017.
Conclusions :
The volume of corneal tissue exported internationally from the US has increased since the 1990s. PK remains the most common type of transplant performed outside of the US. Internationally, corneal ectasia and post-cataract surgery edema are the most common known indications for PK and EK, respectively. However, indication data for corneal transplantation internationally is missing in over 60% of cases, highlighting a need to increase data collection methods abroad to determine trends in corneal transplantation.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.