Evolving indications and surgical trends in keratoplasty: a 7-year analysis from a Chinese tertiary referral center.

Background: The objectives of this study were to investigate the epidemiological characteristics and spectrum of corneal primary diseases among keratoplasty patients in the southern region of Liaoning Province and to study the changing trends in keratoplasty types and corneal graft materials.

Methods: The medical records of 537 patients who underwent keratoplasty at the Department of Ophthalmology of Dalian Third People's Hospital from 2017 to 2023 were retrospectively analyzed. Patient demographic (age and sex), primary corneal disease type, keratoplasty type and corneal graft material data were statistically analyzed.

Results: A total of 537 patients who underwent keratoplasty during the 7 years study period were included. The average age of the patients was 56.35±15.93 years, ranging from 5 to 90 years. There were 348 male patients (64.8%) and 189 female patients (35.2%), with a ratio of 1.84:1. Among the primary corneal diseases, infectious keratitis was the most common (243, 45.25%), followed by corneal leukoma (73, 13.59%), corneal endothelial decompensation (48, 8.94%), traumatic corneal injury (36, 6.70%), corneal graft rejection (34, 6.33%), immune corneal ulcer (33, 6.15%), keratoconus (32, 5.96%), corneal dystrophy and degeneration (28, 5.21%), and corneal tumor (10, 1.86%). Among infectious keratitis cases, the detailed etiology was as follows: fungal keratitis (154, 63.37%), bacterial keratitis (54, 22.22%), viral keratitis (34, 13.99%), and Acanthamoeba keratitis (1, 0.41%). According to the classification of ker atoplasty types, the most common was PKP (265, 49.35%), followed by DALK (129, 24.02%), ALK (116, 21.60%), and EK (27, 5.03%). PKP is still the main surgical method for corneal transplantation, but the proportions of patients who undergo DALK, ALK, and EK are increasing. The corneal graft materials were classified as fresh human donor corneal grafts (297, 55.31%), dehydrated human donor corneal grafts (166, 30.91%), corneal stromal lenticules (4, 0.74%), and bioengineered corneal grafts (70, 13.04%).

Conclusion: Owing to factors such as economic development and industrial distribution, infectious keratitis is the primary cause of keratoplasty in the southern Liaoning region of China, followed by corneal leukoma and corneal endothelial decompensation. Fungal infection is the leading cause of infectious keratitis. The primary keratoplasty type has shifted from PKP to corneal composition transplantation. The range of materials utilized for corneal grafts has expanded significantly and now includes corneal stroma lenticules and bioengineered corneal grafts, in addition to human donor corneal grafts. The present study delineates the evolving surgical patterns and material innovations related to keratoplasty, providing insights for regional ophthalmic policy-making.