Evolution of Corneal Transplantation Techniques and Their Indications in a French Corneal Transplant Unit in 2000–2020

Purpose: This retrospective cohort study assessed the evolution of corneal
transplantation and its indications in the last 21 years (2000–2020) in a specialized
ophthalmology department in a tertiary referral center in France.
Methods: The surgical techniques and indications, patient age and sex, and
postoperative best-corrected visual acuity (BCVA) 6 months after keratoplasty were
extracted.
Results: In total, 1042 eyes underwent keratoplasty in 2000–2020. Annual numbers of
corneal transplantations increased by 2.2-fold. Penetrating keratoplasty (PKP) was the
sole technique for the first 11 years. Descemet stripping automated endothelial
keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) were
introduced in 2011 and 2014, respectively. Cases of both quickly increased,
accounting for 28% and 41% of cases in 2015–2020, respectively. Eventually, DSAEK
and DMEK were respectively used for most pseudophakic bullous keratopathy (PBK)
and all Fuchs endothelial cell dystrophy (FECD) cases. PKP cases declined to 27%.
Deep anterior lamellar keratoplasty (DALK) was rare (3% of all cases). These changes
associated with rises in PBK and particularly FECD cases, and a strong decline in
keratoconus, causing FECD, PBK, and keratoconus to move from being the 4th, 1st,
and 3rd most common indications to the 1st, 2nd, and 6th, respectively. On average,
BCVA improved by 0.1–0.3 logMAR. Patient age dropped steadily over time. Female
predominance was observed.
Conclusions: The invention of DSAEK and then DMEK precipitated an enormous
change in clinical practice and a large expansion of keratoplasty to new indications.
This study confirms and extends previous findings in other countries.