The era of lamellar keratoplasty, evolving surgical techniques in corneal transplantation: the University of Toronto experience

ObjectiveTo analyze the changing trends in corneal transplantation techniques and the way selective lamellar transplantation has influenced our practice.DesignRetrospective survey of all corneal transplants performed by a single practice at Toronto Western Hospital.ParticipantsAll corneal transplants performed by our office since 2002, the year we performed our first lamellar transplant.MethodsWe retrospectively reviewed all keratoplasty procedures performed in our office between January 2002 and December 2010. Procedures were classified as penetrating keratoplasty (PKP); deep lamellar endothelial keratoplasty (DLEK); Descemet's stripping automated endothelial keratoplasty (DSAEK); or deep anterior lamellar keratoplasty (DALK).ResultsA total of 1104 procedures were performed in this period (average, 122.6 per year). Of these, 654 were PKPs (59.3%); 107 DLEKs (9.7%); 219 DSAEKs (19.8%); and 124 DALKs (11.2%). The number of PKPs performed decreased by 61.8% over this 9-year survey. For the last 4 years of the study, the proportions of PKP, DSAEK, and DALK procedures performed were 41%, 40%, and 19%, respectively.ConclusionsThis 9-year audit showed that in less than a decade since its introduction at our institution, selective lamellar transplantation has become the procedure of choice for corneal keratoplasty, accounting for 59% of all transplants performed over the past 4 years.