Changing trends in corneal transplantation: a national review of current practices in the Republic of Ireland
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ORIGINAL ARTICLE
Changing trends in corneal transplantation: a national review of current practices in the Republic of Ireland Katja C. Iselin 1,2 & Emily Greenan 1,2 & Colin Hynes 3 & Sandra Shaw 3 & Tim Fulcher 4 & William J. Power 1 & Barry Quill 1 & Marc Guerin 4 & Weng H. Lee 5 & Conor C. Murphy 1,2 Received: 23 June 2020 / Accepted: 4 August 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background First Irish National Corneal Transplant Registry report. Aim To report about current corneal transplantation practices in Ireland including patient demographics, indications and types of transplant performed and to compare the findings with other developed countries. Methods Nationwide retrospective review of the corneal transplants performed in Ireland between 2016 and 2019. Results Overall, 536 keratoplasties were carried out: 256 (47.8%) Penetrating Keratoplasties (PK), 212 (39.6%) Descemet Stripping Automated Endothelial Keratoplasties (DSAEK), 30 (5.6%) Descemet Membrane Endothelial Keratoplasties (DMEK), and 25 (4.7%) Deep Anterior Lamellar Keratoplasties (DALK). The most common indication was Keratoconus (KC, 19%), followed by Fuchs endothelial dystrophy (FED, 18.8%), and Pseudophakic bullous keratopathy (PBK, 17%). KC (34%) and re-grafting (17%) were the leading indications for PK, whereas FED and PBK were the major indications for DSAEK (38% and 33%) and DMEK (67% and 20%), respectively. During the period studied, the number of transplants increased from 11.3 to 14 grafts per month. The number of PKs remained stable, whereas Endothelial Keratoplasties, DSAEK and DMEK, increased (3.8 to 5.6 and 0.2 to 1.6 per month, respectively), becoming the most commonly performed grafts since 2018. Only a small number of DALK were performed. Conclusions Corneal transplantation in Ireland is following international trends as endothelial procedures have become the most common approach since 2018. However, a low overall number of transplants is performed in Ireland compared with other countries suggesting that care pathways should be implemented to improve access to corneal transplantation. Keywords Corneal graft . Corneal transplantation . Keratoplasty . Transplant registry
Introduction Corneal transplantation, or keratoplasty, is the most common type of tissue transplantation performed worldwide, with over 100,000 carried out per annum across the globe. [1] Its success
* Katja C. Iselin [email protected] 1
Royal Victoria Eye and Ear Hospital, Dublin 2, Ireland
2
RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
3
National Eye Bank, Irish Blood Transfusion Service, St James’ Hospital, Dublin 8, Ireland
4
Mater Misericordiae University Hospital, Dublin 7, Ireland
5
Hermitage Medical Clinic, Dublin, Ireland
is largely due to the ‘immune privileged’ status of the cornea, [2–4] which imparts a much lower risk of allograft rejection than for solid organ transplantation. [5] The diagnostic indications for transplantation vary, but in general, keratoplasty is performed to restore visi
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