Our Summary

This research paper looks at how corneal transplants have changed over the past 21 years (2000-2020) at a specialized eye clinic in France. They studied which surgical techniques were used, why the surgery was performed, the patient’s age and sex, and how well the patient could see 6 months after the operation.

They found that over 1,000 eyes had corneal transplants during this time and the number of these surgeries increased more than twice over. Initially, a technique called Penetrating Keratoplasty (PKP) was used exclusively for the first 11 years. However, new techniques called Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK) were introduced in 2011 and 2014, respectively. These new techniques quickly became popular, making up 28% and 41% of all surgeries between 2015 and 2020.

These new techniques became the preferred method for treating pseudophakic bullous keratopathy (PBK) and all cases of Fuchs endothelial cell dystrophy (FECD), while PKP procedures declined to 27%. Another technique called Deep Anterior Lamellar Keratoplasty (DALK) was rarely used (only 3% of all cases).

As a result of these changes, the most common reasons for corneal transplants shifted. FECD, PBK, and keratoconus moved from being the 4th, 1st, and 3rd most common reasons for surgery to the 1st, 2nd, and 6th, respectively. On average, patients’ vision improved slightly after the surgery. The average age of patients dropped over time and there were more female patients than male.

In conclusion, the development of new surgical techniques (DSAEK and DMEK) led to significant changes in how corneal transplants are performed and who they are performed on. These findings support and expand on previous research conducted in other countries.

FAQs

  1. What were the most common indications for corneal transplantation over the last 21 years?
  2. How have the techniques for corneal transplantation evolved since 2000?
  3. How has the introduction of DSAEK and DMEK affected the prevalence of keratoplasty procedures?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to closely follow postoperative care instructions, including taking prescribed medications, attending follow-up appointments, and avoiding rubbing or putting pressure on the eyes. This can help ensure successful healing and optimal visual outcomes after surgery.

Suitable For

Patients who are typically recommended for corneal transplant include those with conditions such as pseudophakic bullous keratopathy (PBK), Fuchs endothelial cell dystrophy (FECD), and keratoconus. These conditions may lead to significant visual impairment and require surgical intervention to restore vision. The introduction of newer techniques such as Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) has expanded the indications for corneal transplant and improved outcomes for patients with these conditions. Patients who undergo corneal transplant may experience improved best-corrected visual acuity (BCVA) postoperatively, leading to a better quality of life.

Timeline

Before corneal transplant:

  • Patient is diagnosed with a corneal disease or condition such as keratoconus, Fuchs endothelial cell dystrophy, or pseudophakic bullous keratopathy
  • Patient undergoes a thorough evaluation by an ophthalmologist to determine if corneal transplant is necessary
  • Surgical technique is decided based on the specific condition and the patient’s individual needs
  • Patient is placed on a waiting list for a suitable donor cornea
  • Patient undergoes preoperative testing and preparation for surgery

After corneal transplant:

  • Patient undergoes corneal transplant surgery, which can involve penetrating keratoplasty (PKP), Descemet stripping automated endothelial keratoplasty (DSAEK), Descemet membrane endothelial keratoplasty (DMEK), or deep anterior lamellar keratoplasty (DALK)
  • Patient is monitored closely in the immediate postoperative period for any complications or signs of rejection
  • Patient follows a strict postoperative care regimen, including the use of medicated eye drops and regular follow-up appointments
  • Patient’s vision gradually improves over time as the cornea heals and stabilizes
  • Patient’s best-corrected visual acuity (BCVA) is assessed at regular intervals, with the goal of achieving optimal vision
  • Patient may experience fluctuations in vision and may require additional treatments or adjustments to achieve the best possible outcome of the corneal transplant.

What to Ask Your Doctor

  1. What type of corneal transplantation technique will be used in my case?
  2. What are the potential risks and complications associated with the procedure?
  3. What is the expected recovery time and postoperative care plan?
  4. How will my vision be affected after the surgery and what are the expected outcomes?
  5. What are the alternative treatment options available for my condition?
  6. How many corneal transplant surgeries has the doctor performed and what is their success rate?
  7. Will I need to take any medications or follow-up treatments after the surgery?
  8. How long will the transplanted cornea last and are there any long-term considerations I should be aware of?
  9. Are there any specific lifestyle changes I should make before or after the surgery?
  10. Can you provide me with information about support groups or resources for patients undergoing corneal transplant surgery?

Reference

Authors: Malleron V, Bloch F, Zevering Y, Vermion JC, Semler-Collery A, Goetz C, Perone JM. Journal: PLoS One. 2022 Apr 29;17(4):e0263686. doi: 10.1371/journal.pone.0263686. eCollection 2022. PMID: 35486609