Dr. Aditya Pradhan, P15128, Dr. Samar
Kumar Basak, Dr. Bani Biswas (Basak)
Chief author: Dr. Aditya Pradhan
Co-authors: Dr. Bani Biswas (Basak)
Dr. Samar Kr. Basak
Introduction
Prevalence of corneal blindness in India is 0.45%. 6.8 million are corneally blind, 10.6 million people will be unilaterally corneally blind by 20201.
Penetrating keratoplasty is a time tested surgical management for corneal scars, decompensation, dystrophies and ectasias. It is also performed as a globe saving procedure in cases of recalcitrant corneal ulcers.
However, the introduction of component keratoplasty has changed the landscape dramatically. Lamellar keratoplasty in the form of DALK, DSEK/DSAEK and DMEK has made it possible to provide targeted therapy for existing and newer indications. Keratoprosthesis is now an available option in end-stage disease not amenable to conventional keratoplasty.
A wealth of literature is available from the western world which has analysed this changing landscape of corneal transplantation. However only limited literature is available which takes a look at the situation in our country.
Materials and Methods:
This was a retrospective study of data conducted at Prova Eye Bank, Disha Eye Hospitals in Barrackpore for the period from January 2011 to December 2015. Eye bank records were analysed for number of keratoplasties performed, types of keratoplasties performed and the indications for each of them.
Results:
A total of 5567 corneal transplants were performed in the study period.The number of keratoplasties ranged from 891 in 2011 to 1258 in 2015.The top 3 indications were active infectious keratitis(40.18%),bullous keratopathy(18.93%) and corneal scar(18.16%).There was a significant increase in the number of EK and a slow increase in the number of DALK. Keratoplasty for failed graft showed a rising trend (11.19%). PK remained the most common technique of transplant followed by DSEK.
| Table 1: Types of keratoplasties performed between 2011 to 2015 | ||||||
| Year | PK | DSEK/DSAEK | K-PRO | Therapeutic PK | DALK | Tectonic |
| 2011 | 304 | 237 | 11 | 288 | 23 | 28 |
| 2012 | 318 | 240 | 17 | 358 | 25 | 23 |
| 2013 | 326 | 279 | 14 | 520 | 29 | 26 |
| 2014 | 321 | 307 | 14 | 540 | 33 | 49 |
| 2015 | 302 | 289 | 14 | 531 | 43 | 58 |
| TOTAL | 1571 | 1352 | 70 | 2237 | 153 | 184 |
| Table 2: Indications for keratoplasties performed between 2011 to 2015 | ||||||
| Indications | 2011 | 2012 | 2013 | 2014 | 2015 | TOTAL |
| Active infectious keratitis | 288 | 358 | 520 | 540 | 531 | 2237 |
| Corneal scarring | 250 | 211 | 195 | 175 | 180 | 1011 |
| ABK/PBK | 181 | 175 | 200 | 250 | 248 | 1054 |
| Keratoconus | 21 | 21 | 29 | 33 | 41 | 145 |
| Failed graft | 78 | 100 | 120 | 150 | 175 | 623 |
| CHED | 3 | 2 | 2 | 0 | 2 | 9 |
| FECD | 44 | 60 | 77 | 57 | 56 | 294 |
| Non-endothelial dystrophies | 23 | 30 | 25 | 27 | 15 | 120 |
| Chemical/thermal injury | 0 | 15 | 20 | 5 | 3 | 43 |
| Autoimmune disorders | 3 | 8 | 6 | 7 | 7 | 31 |
Discussion:
In this study, we reviewed the indications for corneal transplantation at our centre in Eastern India and also the changing trends therein. Dandona et al2 looked at indications for penetrating keratoplasty. The top three indications in their study were corneal scarring (28.1%), regraft (17.1%) and active infectious keratitis (12.2%). This is in stark contrast with our study where active infectious keratitis accounted for 40.18% of the total keratoplasties and corneal scar accounted for 18.16%.
Park et al3 in their study analysed data from the EBAA for the past 10 years and found a definite decline in the number of penetrating keratoplasties and its replacement by lamellar keratoplasties. This trend is not evident in our study due the large burden of infectious keratitis. Corneal decompensation (Fuchs’/post cataract) was the most common indication in their study (34%). Like their study however, there was a definite increase in the number of lamellar keratoplasties in our study.
Tan et al4 in their study concluded that the top three indications were bullous keratopathy (23.4%), post infectious scarring (12.9%) and regrafts (12.4%). However, the study did not take a look at lamellar keratoplasty. There was a definite increase in the number of regrafts in our study over the 5-year period.
Galvis et al5 found that infectious keratitis became the second most common indication in their study after bullous keratopathy.
Conclusion:
Active infectious keratitis is the leading indication for performing a corneal transplant in this part of the country which is in contrast with the published literature. However, lamellar keratoplasty is on the rise in line with many studies. Regrafting has become an important indication for keratoplasty not only in our study but some others as well.
There is a paucity of good quality data in our country and the lack of a national transplant database has worsened the situation. Establishment of such a database would help us in better understanding the evolution of keratoplasty and geographical differences for the same.
References:
- Vashist P, et al. Burden of corneal blindness in India. Indian J Community Med. 2013;38(4):198-206
- Dandona L, Ragu K, Janarthanan M et al. Indications for penetrating keratoplasty in India. Indian J Ophthalmol. 1997;45(3):163-8.
- Park C, Lee J, Gore P, Lim C, Chuck R. Keratoplasty in the United States. Ophthalmology. 2015;122(12):2432-2442.
- Tan D, Janardhanan P, Zhou H et al. Penetrating Keratoplasty in Asian Eyes. Ophthalmology.2008;115(6):975-982.e1.
- Galvis V, Tello A, Gomez AJ et al. Corneal transplantation at an ophthalmological referral center in Colombia: indications and techniques (2004-2011). Open Ophthalmol J. 2013; 7:30-3.