Changing indications for penetrating keratoplasty over a 20-year period, 1985-2004

BACKGROUND: The aim of the study was to determine the changing indications for penetrating keratoplasty (PK) over the 20 years from 1.1.1985 through 31.12.2004 at our Ophthalmology Department as well as to identify additional surgical interventions. PATIENTS AND METHODS: Medical records of all 268 patients (290 eyes) who underwent PK at our Ophthalmology Department Teaching Hospital Maribor over the 20-year period (1985-2004) were reviewed retrospectively. All PK were divided into two groups: the first group comprised 121 eyes operated in the first 10 years (1985-1994) and the second one comprised those operated in the last 10 years (1995-2004). RESULTS: During the period of 20 years (1984-2004), the most common indication for PK was aphakic/pseudophakic bullous keratopathy (23.1 %). Keratoconus was the second most common indication for PK (21.7 %), followed by corneal scars (21.4 %). In the first 10 years of the study (1985 to 1994) the most common indications were corneal scars (28.9 %), keratoconus (22.3 %) and corneal dystrophy (19.8 %). Over the second 10 years (1995 to 2004) the three most common indications were bullous keratopathy (29 %), keratoconus (21.3 %) and corneal scars (16.9 %). There was a dramatic increase in the number of PK for failed corneal transplants, from 3.3 % in the first to 12.4 % in the second period (+ 275.8 %) and for bullous keratopathy (+ 94.6 %) as well as a decrease for corneal scarring (-41.5 %) and corneal dystrophy (-40.4 %). Additional surgical interventions increased from 21.5 % in the first 10 years to 28.4 % (+ 32.1 %) in the second 10 years. CONCLUSIONS: Bullous keratopathy was the leading indication for PK during the last 10 years (1994-2005). Keratoconus was the second leading indication in both 10 year periods. Regrafting showed a significant increasing trend in the last 10 years.