Skip to main content
Download PDF

Evolving indications and surgical techniques for corneal transplantation at a tertiary eye care center in southern China

BMC Ophthalmology volume 24, Article number: 413 (2024) Cite this article

Abstract

Background

This retrospective study aimed to analyze the evolution of primary indications and surgical techniques for corneal transplantation in Southern China from 2012 to 2021.

Methods

The medical charts of all patients who underwent keratoplasty between January 2012 and December 2021 at Zhongshan Ophthalmic Centre, Sun Yat-Sen University, Guangzhou, Southern China were reviewed. We collected and analyzed the primary indications for corneal transplantation and the surgical methods used in each keratoplasty.

Results

The total number of corneal transplantations was 7,286 during this decade, increasing from 210 cases in 2012 to 1054 cases in 2021. The primary indications for keratoplasty included acquired nontraumatic corneal diseases (56.2%), congenital corneal abnormalities (16.4%), acquired traumatic corneal diseases (14.0%), and regraft (13.4%). Infectious keratitis was the leading indication among all keratoplasties (18.5%), followed by regraft (13.4%). Over the decade, the proportion of infectious keratitis gradually decreased (P = 0.013), while the proportion of regraft increased (P = 0.019). The predominant surgical technique was penetrating keratoplasty (PKP), accounting for 56.7%. However, the number of deep anterior lamellar keratoplasty (DALK) and endothelial keratoplasty (EK) significantly increased from 2012 to 2021 (P = 0.007 and P = 0.002).

Conclusions

The annual number of corneal transplants significantly increased from 2012 to 2021. In the past decade, infectious keratitis and regraft have become the leading primary indications for corneal transplantation. Although the use of customized lamellar techniques has dramatically increased, PKP remains the predominant surgical technique for keratoplasty.

Peer Review reports

Background

Corneal blindness is a global issue that causes irreversible visual impairment and significantly impacts the quality of life for approximately 8 million people worldwide [1,2,3]. Due to its immune privilege [4], corneal transplantation is the most successful and frequently performed solid organ transplant globally [5, 6]. In recent years, novel treatments, such as Rho-kinase inhibitors, gene therapy, artificial endothelial substitutes, cultivated endothelial cell therapy are predicted to exhibit promising results for the treatment of endothelial diseases, but the long-term effect of treatment is unknown [7]. However, the most effective treatment is still corneal transplantation. Advancements in medical technology have significantly altered surgical techniques for corneal transplantation [8], shifting from full-thickness penetrating keratoplasty (PKP) to newer lamellar keratoplasty techniques that replace only the damaged layers of the cornea, thereby minimizing the risk of immunological graft rejection and improving graft survival rate [9,10,11]. Posterior lamellar keratoplasty, also recognized as endothelial keratoplasty (EK), mainly includes descemet stripping endothelial keratoplasty (DSEK) and descemet membrane endothelial keratoplasty (DMEK), has become the preferred choice for corneal endothelial disease on account of the faster recovery and better refractive outcomes [12]. Compared with DSEK, DMEK could provide a lower rejection rate and better visual rehabilitation, although it has a higher complication rate and steeper learning curve [13]. The emergence of various innovative approaches and tips from tissue preparation to graft unfolding can help ophthalmologists master the DMEK surgery more quickly [12, 13].

The primary indications for keratoplasty have varied across different regions over time. In developed countries [14,15,16], Fuchs’ endothelial dystrophy (FED) is the top indication for corneal transplantation, while infectious keratitis is the main indication in developing countries [17, 18]. Due to improvements in surgical techniques, the surgical options for certain corneal diseases have changed [19]. Therefore, it is crucial to investigate the evolving trends in indications and surgical techniques for keratoplasty to enhance preoperative assessment and surgical selection in different countries.

Several single-center studies have documented the changing trends in the indications and surgical techniques for corneal transplantation across various regions in China [20,21,22,23]. However, any related data have not yet been published from the Zhongshan Ophthalmic Center of Sun Yat-Sen University, the largest corneal transplant center in southern China [24]. Indications for corneal transplantation may vary depending on geographic region, socioeconomic status, and public health conditions. Therefore, this retrospective study was conducted and the medical charts of performed corneal transplants were reviewed at the Zhongshan Ophthalmic Center from 2012 to 2021 for investigating the changes in primary indications and surgical methods for corneal transplantation in southern China, which could help junior ophthalmologists to better understand the clinical features of corneal transplantation in recent years.

Methods

Patients

The medical records were reviewed for all patients who underwent corneal transplantation from 1 January 2012 to 31 December 2021 at Zhongshan Ophthalmic Centre, Sun Yat-Sen University in Guangzhou, China. Detailed data were collected, including demographic information, primary indications for corneal transplantation, surgical techniques of each keratoplasty, and other relevant details. This study was approved by the Ethics Committee of Zhongshan Ophthalmic Center (approval number: 2024KYPJ070) and conducted in accordance with the Declaration of Helsinki.

Indications

This study categorized the primary indications for keratoplasty into four distinct groups [25], including: (1) acquired nontraumatic corneal diseases, (2) acquired traumatic corneal diseases, (3) congenital corneal abnormalities, and (4) re-graft. Within the first category, acquired nontraumatic corneal diseases were subdivided into the ulcer group and the non-ulcer group. The ulcer group encompassed infectious, immune, exposure, and neurotrophic keratitis. Infectious keratitis was further classified into fungal, bacterial, viral, and acanthamobic keratitis based on the specific pathogen involved. Cases with unidentifiable pathogens were classified as unknown in this category. The non-ulcer group was comprised of keratoconus, endothelial dysfunction/bullous keratopathy (including those caused by FED), corneal degeneration, corneal tumors, corneal scarring, and unidentified conditions. Acquired traumatic corneal diseases included mechanical, chemical, thermal, and other injuries. Congenital corneal abnormalities encompassed congenital corneal opacity, limbal dermoid, and corneal dystrophy. FED was excluded from the corneal dystrophy category to prevent duplication. Eyes with a history of keratoplasty were preferentially classified as regraft.

Surgical techniques

In this study, the surgical techniques for corneal transplantation included PKP, anterior lamellar keratoplasty (ALK), deep anterior lamellar keratoplasty (DALK), EK, keratoprosthesis and acellular porcine corneal stroma (APCS) transplantation.

Statistical analysis

Data were analyzed using SPSS software for Microsoft Windows 10.0 (version 26; SPSS Inc, Chicago, IL). This study evaluated trends in primary indications and surgical techniques for keratoplasty using the Pearson correlation coefficient and linear regression analyses. Statistical significance was defined as a P value < 0.05.

Results

Number of corneal transplantation

According to medical records, 7,286 corneal transplants were performed over the past ten years. And the annual number of corneal transplants increased significantly from 210 cases in 2012 to 1054 cases in 2021. (Fig. 1) (P < 0.001).

Fig. 1
figure 1

The annual number of corneal transplantations between 2012 and 2021

Full size image

Indications for corneal transplantation

The primary indications for 7,286 keratoplasties are detailed in Table 1. Among all cases, the leading category was acquired nontraumatic corneal diseases (4,093 cases, 56.2%), followed by congenital corneal abnormalities (1,198 cases, 16.4%), acquired traumatic corneal diseases (1,020 cases, 14.0%) and regraft (975 cases, 13.4%) (Table 1).

Table 1 Primary indications for corneal transplantation from 2012 to 2021
Full size table

Among all corneal transplants, the top ten indications between 2012 and 2021 were infectious keratitis (1,347 cases, 18.5%), regraft (975 cases, 13.4%), corneal scarring (801 cases, 11.0%), endothelial dysfunction/bullous keratopathy (776 cases, 10.7%), limbal dermoid (714 cases, 9.8%), keratoconus (616 cases, 8.5%), chemical injury (476 cases, 6.5%), mechanical injury (403 cases, 5.5%), congenital corneal opacity (286 cases, 3.9%) and immune keratitis (260 cases, 3.6%) (Table 1; Fig. 2).

Fig. 2
figure 2

The top ten indications for corneal transplantation between 2012 and 2021

Full size image

Acquired nontraumatic corneal diseases

Although acquired nontraumatic corneal diseases accounted for the most proportion among all keratoplasties, the proportion had no significantly increasing change during the past decade (P = 0.099; Fig. 3a). The leading indication in this category over the last ten years was infectious keratitis (n = 1,347, 18.5%), followed by corneal scarring (n = 801, 11.0%), endothelial dysfunction/bullous keratopathy (n = 776, 10.7%) and keratoconus (n = 616, 8.5%) (Table 1). However, the proportion of infectious keratitis in all keratoplasties gradually decreased from 26.2% in 2012 to 12.7% in 2021 (P = 0.013, Fig. 3e). For infectious keratitis, the largest proportion was due to unknown pathogens (52.0%), followed by fungal (32.1%), viral (11.8%), bacterial (3.4%) and amebic keratitis (0.7%). The proportions of these etiologies remained stable from 2012 to 2021 (P = 0.081, P = 0.240, P = 0.906, P = 0.057 and P = 0.202, respectively; Fig. 3f). The proportion of endothelial dysfunction/bullous keratopathy revealed a significant increasing change from 5.2 to 12.1% during this decade (P = 0.040, Fig. 3g), predominantly caused by intraocular surgeries (52.3%) (Fig. 4a), including cataract surgery (52%), combined glaucoma and cataract surgery (22%), anti-glaucoma surgery (16%) and other intraocular surgeries (10%) (Fig. 4b). The proportion of keratoconus did not show a significant increasing trend over the last ten years (P = 0.400, Fig. 3h).

Fig. 3
figure 3

Changing trend of primary indications for corneal transplant from 2012 to 2021. (a) The proportion of acquired nontraumatic corneal diseases. (b) The proportion of acquired traumatic corneal diseases. (c) The proportion of congenital corneal abnormalities. (d) The proportion of regraft. (e) The proportion of infectious keratitis. (f) The proportion of different pathogens in infectious keratitis. (g) The proportion of endothelial dysfunction/bullous keratopathy. (h) The proportion of keratoconus

Full size image
Fig. 4
figure 4

The common causes for endothelial dysfunction/bullous keratopathy over the last 10 years (a) and the different proportions of intraocular surgery (b). FED, Fuchs’ endothelial dystrophy. ICE, Iridocorneal endothelial syndrome

Full size image

Acquired traumatic corneal diseases

The proportion of acquired traumatic corneal diseases had no significant change from 2012 to 2021 (P = 0.106, shown in Fig. 3b). The leading indication was chemical injury (46.7%), followed by mechanical injury (39.4%), thermal injury (13.3%) and other injury (0.6%) (Table 1). In this category, no significant trends were found in the proportion of chemical, mechanical, thermal and other injury over the last ten years (P = 0.661, P = 0.785, P = 0.568 and P = 0.111, respectively) (Table 1).

Congenital corneal abnormalities and regraft

No significant change was observed in the proportion of congenital corneal abnormalities during this decade (P = 0.531, Fig. 3c). In contrast, the proportion of regraft among all keratoplasties showed a significant rising trend from 3.8% in 2012 to 18.3% in 2021 (P = 0.019, Fig. 3d). Among congenital corneal abnormalities, limbal dermoid was the major indication, accounting for 59.6%, but its proportion decreased significantly from 80.0% in 2012 to 41.2% in 2021 (P = 0.002; Table 1). The second indication was congenital corneal opacity (23.9%), which showed a significantly increasing trend from 8.6% in 2012 to 33.3% in 2021 (P < 0.001), followed by corneal dystrophy (15.3%), whose proportion did not change significantly over the decade (P = 0.318), and others (1.3%) (Table 1).

Surgical techniques of corneal transplantation

The most common surgical technique for corneal transplantation over the last ten years was PKP, accounting for 56.7%, followed by ALK (23.3%), DALK (11.7%), EK (7.6%) and others (0.7%) which included both APCS transplantation and keratoprosthesis (Fig. 5).

Fig. 5
figure 5

The proportion of surgical techniques for corneal transplantation from 2012 to 2021. PKP, penetrating keratoplasty. ALK, anterior lamellar keratoplasty. DALK, deep anterior lamellar keratoplasty. EK, endothelial keratoplasty. APCS transplantation, acellular porcine corneal stroma transplantation

Full size image

The number of PKP, DALK, and EK showed a significant rising trend from 2012 to 2021 (P = 0.001, P = 0.007 and P = 0.002, respectively, Fig. 6a). No significant trend of change was observed in the number of ALK during this decade (P = 0.412, Fig. 6a), but the proportion of ALK dramatically decreased from 38.1% in 2012 to 16.1% in 2021 (P = 0.002, Fig. 6b). Meanwhile, a significant increasing change was found in the proportion of EK from 1.4% in 2012 to 9.5%in 2021 (P = 0.004, shown in Fig. 6b). The proportion of PKP and DALK had no significant change in this decade (P = 0.752 and P = 0.056, respectively, Fig. 6b).

Fig. 6
figure 6

The trend of surgical techniques for corneal transplantation from 2012 to 2021. (a) The number of PKP, ALK, DALK, and EK. (b) The annual proportion of PKP, ALK, DALK, and EK. (c) The number of PKP, ALK, DALK for keratoconus. (d) The annual proportion of PKP and EK for endothelial dysfunction/bullous keratopathy. PKP, penetrating keratoplasty. ALK, anterior lamellar keratoplast. DALK, deep anterior lamellar keratoplasty. EK, endothelial keratoplasty

Full size image

For the treatment of keratoconus, the number of DALK showed a significant increasing trend over the last ten years (P = 0.001), and the proportion of DALK increased significantly from 33.3% in 2012 to 61.2% in 2021 (P = 0.005, Fig. 6c), indicating that DALK had taken the place of PKP to be the leading surgical technique. In the treatment of endothelial dysfunction/bullous keratopathy, PKP and EK were the two main surgical methods over the decade. A significant rising change was found in the proportion of EK from 27.3% in 2012 to 71.1% in 2021 (P < 0.001, Fig. 6d), which showed that EK had replaced PKP and become the major surgical method.

Discussion

This is the first study to analyze recent changes in the indications and surgical techniques for corneal transplantation in southern China from January 2012 to December 2021. The number of corneal transplants has increased significantly over the last ten years, consistent with trends observed in various countries worldwide [1, 5, 9], due to the standardized eye banking management [26], the use of immunosuppressive agents, and advancements in microsurgical techniques [8, 27]. At the same time, this study found that the increase rate of corneal transplants gradually declined from 2012 to 2021, which might be related to the donor shortage [27].

According to this study, acquired nontraumatic corneal diseases accounted for 56.2%, followed by congenital corneal abnormalities (16.4%), acquired traumatic corneal diseases (14.0%), and regraft (13.4%), which was similar to the findings reported in the East China from 2010 to 2019 [25]. More than half of the indications for corneal transplantation were due to acquired conditions. This means that it is important to prevent the occurrence of serious corneal disorders for reducing corneal blindness [28].

Infectious keratitis was the leading indication among all keratoplasties over the past ten years in this study, which is in agreement with some previous studies from different regions in China [15, 18, 22] as well as in some developing countries such as Vietnam [29] and India [30]. This is different from that in developed countries, where the predominant indication for corneal transplants was corneal endothelial dysfunction [31] or keratoconus [32]. Although infectious keratitis was leading cause, its proportion was significantly decreased from 26.2% in 2012 to 12.7% in 2021, the number of infectious keratitis patients increased from 2012 to 2021. The phenomenon of this change may be attributed to the increase in other categories of transplant indications.

In this study, the category of unknown pathogens accounted for 52% of infectious keratitis. The possible reasons may be the history of treatment at a local hospital, incomplete medical records, and insufficient corneal tissue sample for culture especially in those with already or near corneal perforation [33]. The major pathogen in this study was fungi. Compared with other types of infectious keratitis, fungal keratitis had a worse prognosis [34]. Most patients with fungal keratitis may result in moderate to severe visual impairment [35]. Therefore, early diagnosis and effective treatment for fungal keratitis are essential.

Regraft was the second most common indication in both its number and proportion with an increasing trend. This was consistent with studies from other countries [36,37,38]. This may be due to graft failures over time [39, 40], and priority donor corneal distribution to individuals with more severe eye conditions [20]. Endothelial dysfunction ranked as the fourth most common indication for corneal transplants in this study. The leading cause was the history of intraocular surgery which included cataract surgery (52%), combination of glaucoma and cataract surgery (22%), anti-glaucoma surgery (16%), whereas FED in western countries [41].

In this study, PKP remained the main surgical technique for corneal transplantation and its annual proportion kept at stable, which was consistent with most Asian surveys [3]. Meanwhile, the proportion of EK had increased significantly from 1.4% in 2012 to 9.5% in 2021. EK is replacing PKP as the most common surgical technique for treating endothelial dysfunction in this study. The retrospective and descriptive study from 2013 to 2022 in Andalusia had similar findings, illustrated the importance of appealing for cornea donations and highlighted that the growth of lamellar techniques was closely linked to eye bank management [42]. However, the proportion of EK in this study is far lower than that in the United States [43], which may be due to different indications. Moreover, DALK had been the leading surgical method for treating of keratoconus. DALK could reduce immunologic rejection [44].

There are several limitations in this retrospective study. As a single-center study, it was inevitable for selection bias. The primary diagnosis was used for classification and some cases were classified as the category of “unknown or other” based on incomplete medical charts. Furthermore, the data quality relied on accurate descriptions by different doctors. The absence of adequate corneal tissue sample for culture may affect the proportion of different pathogens in infectious keratitis. The follow-up data were lack, such as postoperative complications, intraocular pressure, best corrected visual acuity, and graft survival time, leading to an inability to further analyse the prognosis of different indications and surgical procedures. Therefore, a multicenter and prospective study is necessary to be conduct for the outcomes of different corneal transplants, which is also of our future direction.

Conclusion

The most common primary indications for corneal transplantation in Southern China from 2012 to 2021 were infectious keratitis and regraft. PKP remained the leading surgical method, while DALK and EK were increasingly performed.

Data availability

The data generated during this study are available from the corresponding author upon reasonable request.

Abbreviations

PKP:

Penetrating keratoplasty

ALK:

Anterior lamellar keratoplasty

DALK:

Deep anterior lamellar keratoplasty

EK:

Endothelial keratoplasty

FED:

Fuchs’ endothelial dystrophy

APCS:

Acellular porcine corneal stroma

DSEK:

Descemet stripping endothelial keratoplasty

DMEK:

Descemet membrane endothelial keratoplasty

References

  1. Anitha V, Tandon R, Shah SG, Radhakrishnan N, Singh S, Murugesan V, et al. Corneal blindness and eye banking: current strategies and best practices. Indian J Ophthalmol. 2023;71(9):3142–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Robaei D, Watson S. Corneal blindness: a global problem. Clin Exp Ophthalmol. 2014;42(3):213–4.

    Article  PubMed  Google Scholar 

  3. Tran TM, Duong H, Bonnet C, Kashanchi A, Buckshey A, Aldave AJ. Corneal blindness in Asia: a systematic review and Meta-analysis to identify challenges and opportunities. Cornea. 2020;39(9):1196–205.

    Article  PubMed  Google Scholar 

  4. Hori J, Yamaguchi T, Keino H, Hamrah P, Maruyama K. Immune privilege in corneal transplantation. Prog Retin Eye Res. 2019;72:100758.

    Article  CAS  PubMed  Google Scholar 

  5. Gain P, Jullienne R, He Z, Aldossary M, Acquart S, Cognasse F, et al. Global survey of corneal transplantation and Eye Banking. JAMA Ophthalmol. 2016;134(2):167–73.

    Article  PubMed  Google Scholar 

  6. Singh R, Gupta N, Vanathi M, Tandon R. Corneal transplantation in the modern era. Indian J Med Res. 2019;150(1):7–22.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rocha-de-Lossada C, Rachwani-Anil R, Borroni D, Sánchez-González JM, Esteves-Marques R, Soler-Ferrández FL, et al. New Horizons in the treatment of corneal endothelial dysfunction. J Ophthalmol. 2021;2021:6644114.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tan DT, Dart JK, Holland EJ, Kinoshita S. Corneal transplantation. Lancet. 2012;379(9827):1749–61.

    Article  PubMed  Google Scholar 

  9. Ple-Plakon PA, Shtein RM. Trends in corneal transplantation: indications and techniques. Curr Opin Ophthalmol. 2014;25(4):300–5.

    Article  PubMed  Google Scholar 

  10. Liu S, Wong YL, Walkden A. Current perspectives on corneal transplantation. Clin Ophthalmol. 2022;16:631–46.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Arenas E, Esquenazi S, Anwar M, Terry M. Lamellar corneal transplantation. Surv Ophthalmol. 2012;57(6):510–29.

    Article  PubMed  Google Scholar 

  12. Borroni D, Rocha de Lossada C, Parekh M, Gadhvi K, Bonzano C, Romano V, et al. Tips, tricks, and guides in Descemet membrane endothelial keratoplasty learning curve. J Ophthalmol. 2021;2021:1819454.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Borroni D, Gadhvi K, Wojcik G, Pennisi F, Vallabh NA, Galeone A, et al. The influence of Speed during stripping in Descemet membrane endothelial keratoplasty tissue Preparation. Cornea. 2020;39(9):1086–90.

    Article  PubMed  Google Scholar 

  14. Park CY, Lee JK, Gore PK, Lim CY, Chuck RS. Keratoplasty in the United States: a 10-Year review from 2005 through 2014. Ophthalmology. 2015;122(12):2432–42.

    Article  PubMed  Google Scholar 

  15. Tan JC, Holland SP, Dubord PJ, Moloney G, McCarthy M, Yeung SN. Evolving indications for and trends in keratoplasty in British Columbia, Canada, from 2002 to 2011: a 10-year review. Cornea. 2014;33(3):252–6.

    Article  PubMed  Google Scholar 

  16. Flockerzi E, Maier P, Böhringer D, Reinshagen H, Kruse F, Cursiefen C, et al. Trends in corneal transplantation from 2001 to 2016 in Germany: a report of the DOG-Section cornea and its Keratoplasty Registry. Am J Ophthalmol. 2018;188:91–8.

    Article  PubMed  Google Scholar 

  17. Kaur A, Parida P, Priyadarshini SR, Mohanty A, Sahu SK, Das S. Indications and types of keratoplasties: Trends in the past 10 years (2011–2020) in Eastern India. Indian J Ophthalmol. 2023;71(9):3166–70.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Xie L, Qi F, Gao H, Wang T, Shi W, Zhao J. Major shifts in corneal transplantation procedures in north China: 5316 eyes over 12 years. Br J Ophthalmol. 2009;93(10):1291–5.

    Article  CAS  PubMed  Google Scholar 

  19. Xiao G, Tsou BC, Soiberman US, Prescott CR, Srikumaran D, Woreta FA. Keratoplasty in the United States: Trends and indications from 2015 to 2020. Cornea. 2023;42(11):1360–4.

    Article  PubMed  Google Scholar 

  20. Wang TW, Chi YC, Hsu PS, Kuo NW, Chen JL. Changing Indications for Corneal Transplantations in Southern Taiwan from 2008 to 2018. Eye Contact Lens. 2020;46(5):301–5.

    Article  PubMed  Google Scholar 

  21. Tan H, Lin M, Gou Q, Li A, Gu F, Liu Q, et al. Trends in corneal transplantation and characteristics of donors in the Chongqing Eye Bank, China: a retrospective study, 1999–2018. Front Med (Lausanne). 2021;8:750898.

    Article  PubMed  Google Scholar 

  22. Wang JY, Xie LX, Song XS, Zhao J. Trends in the indications for penetrating keratoplasty in Shandong, 2005–2010. Int J Ophthalmol. 2011;4(5):492–7.

    PubMed  PubMed Central  Google Scholar 

  23. Wan X, Yao W, Zhao S, Xu J, Le Q. Indications and Surgical techniques for repeat corneal transplantation in Eastern China: a twelve-year study. J Ophthalmol. 2021;2021:5514004.

    PubMed  PubMed Central  Google Scholar 

  24. Gao H, Huang T, Pan Z, Wu J, Xu J, Hong J, et al. Survey report on keratoplasty in China: a 5-year review from 2014 to 2018. PLoS ONE. 2020;15(10):e0239939.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Zhao S, Wan X, Yao W, Xu J, Le Q. Trends of corneal transplantation in adults from 2010 to 2019 in East China: a 10-Year experience. Ophthalmic Res. 2022;65(1):30–9.

    Article  PubMed  Google Scholar 

  26. Chaurasia S, Mohamed A, Garg P, Balasubramanian D, Rao GN. Thirty years of eye bank experience at a single centre in India. Int Ophthalmol. 2020;40(1):81–8.

    Article  PubMed  Google Scholar 

  27. Wong KH, Kam KW, Chen LJ, Young AL. Corneal blindness and current major treatment concern-graft scarcity. Int J Ophthalmol. 2017;10(7):1154–62.

    PubMed  PubMed Central  Google Scholar 

  28. Garg P, Krishna PV, Stratis AK, Gopinathan U. The value of corneal transplantation in reducing blindness. Eye (Lond). 2005;19(10):1106–14.

    Article  CAS  PubMed  Google Scholar 

  29. Dong PN, Han TN, Aldave AJ, Chau HT. Indications for and techniques of keratoplasty at Vietnam National Institute of Ophthalmology. Int J Ophthalmol. 2016;9(3):379–83.

    PubMed  PubMed Central  Google Scholar 

  30. Sharma N, Arora T, Singhal D, Maharana PK, Garg P, Nagpal R, et al. Procurement, storage and utilization trends of eye banks in India. Indian J Ophthalmol. 2019;67(7):1056–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Droutsas K, Bagikos G, Miltsakakis D, Georgalas I, Lazaridis A, Chatzistefanou K, et al. Trends in indications and techniques of corneal transplantation from 1999 through 2015 at a Tertiary Referral Center in Athens, Greece. J Ophthalmol. 2018;2018:9132083.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Iselin KC, Greenan E, Hynes C, Shaw S, Fulcher T, Power WJ, et al. Changing trends in corneal transplantation: a national review of current practices in the Republic of Ireland. Ir J Med Sci. 2021;190(2):825–34.

    Article  PubMed  Google Scholar 

  33. Das AV, Chaurasia S, Joseph J, Roy A, Das S, Fernandes M. Clinical profile and microbiological trends of therapeutic keratoplasty at a network of tertiary care ophthalmology centers in India. Int Ophthalmol. 2022;42(5):1391–9.

    Article  PubMed  Google Scholar 

  34. Brown L, Leck AK, Gichangi M, Burton MJ, Denning DW. The global incidence and diagnosis of fungal keratitis. Lancet Infect Dis. 2021;21(3):e49–57.

    Article  PubMed  Google Scholar 

  35. Mills B, Radhakrishnan N, Karthikeyan Rajapandian SG, Rameshkumar G, Lalitha P, Prajna NV. The role of fungi in fungal keratitis. Exp Eye Res. 2021;202:108372.

    Article  CAS  PubMed  Google Scholar 

  36. Hsu KM, Chang SH, Brothers W, Edelstein SL, Hsu HY, Harocopos GJ. Indications for Keratoplasty at 3 academic centers from 2002 to 2012. Eye Contact Lens. 2016;42(6):374–9.

    Article  PubMed  Google Scholar 

  37. Noureddine S, Garcin T, Puyraveau M, Thizy A, Ben Moussa O, Peyret B, et al. Repeat corneal transplantation: indication, surgical technique, and early graft failures trends in France from 2004 to 2019. Cell Tissue Bank. 2022;23(4):729–38.

    Article  PubMed  Google Scholar 

  38. Aboshiha J, Jones MNA, Hopkinson CL, Larkin DFP. Differential Survival of Penetrating and Lamellar Transplants in Management of failed corneal grafts. JAMA Ophthalmol. 2018;136(8):859–65.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yin J. Advances in corneal graft rejection. Curr Opin Ophthalmol. 2021;32(4):331–7.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Deshmukh R, Murthy SI, Rapuano CJ, Vajpayee RB. Graft rejection in component keratoplasty. Indian J Ophthalmol. 2023;71(3):698–706.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Price MO, Mehta JS, Jurkunas UV, Price FW. Jr. Corneal endothelial dysfunction: evolving understanding and treatment options. Prog Retin Eye Res. 2021;82:100904.

    Article  PubMed  Google Scholar 

  42. Rodríguez-Calvo-de-Mora M, Giménez-Almenara-Amo J, Mataix-Albert B, Arias-Alcalá M, García-Montesinos-Gutiérrez J, Rocha-de-Lossada C, et al. Andalusian Public Eye-Banks: a decade of continuous improvement. Arch Soc Esp Oftalmol (Engl Ed). 2024;99(9):383–91.

    Article  PubMed  Google Scholar 

  43. Price MO, Gupta P, Lass J, Price FW. Jr. EK (DLEK, DSEK, DMEK): New Frontier in Cornea surgery. Annu Rev Vis Sci. 2017;3:69–90.

    Article  PubMed  Google Scholar 

  44. Henein C, Nanavaty MA. Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus. Cont Lens Anterior Eye. 2017;40(1):3–14.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This study was funded by the National Natural Science Foundation of China (Grant number 82401211), Regional Consolidated Fund of Guangdong Province (Grant Number 2023A1515110531), China Postdoctoral Science Foundation (Grant Number 2023M744071), and the Postdoctoral Fellowship Program of CPSF (Grant number GZB20230901).

Author information

Authors and Affiliations

  1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China

    Shu-rong Li, Zhe-wen Zheng, Jin-yu Zhang & Shi-you Zhou

  2. Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, China

    Yao-lei Du

Authors
  1. Shu-rong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yao-lei Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhe-wen Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin-yu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shi-you Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SR. L, YL.D, and ZW. Z collected the patient data. SR. L analyzed the data and wrote the manuscript. JY.Z and SY.Z designed and revised the manuscript. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Jin-yu Zhang or Shi-you Zhou.

Ethics declarations

Ethics approval and consent to participate

This study received approval from the Institutional Review Board of Zhongshan Ophthalmic Centre, Sun Yat-Sen University (approval number: 2024KYPJ070) and conducted in accordance with the Declaration of Helsinki. This study is retrospective and the data are anonymous, and the requirement for informed consent was therefore waived by the Institutional Review Board.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Sr., Du, Yl., Zheng, Zw. et al. Evolving indications and surgical techniques for corneal transplantation at a tertiary eye care center in southern China. BMC Ophthalmol 24, 413 (2024). https://doi.org/10.1186/s12886-024-03689-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12886-024-03689-y

Keywords

BMC Ophthalmology

ISSN: 1471-2415

Contact us