Five Year Review of All Examined Corneal Tissue in a Tertiary Eye Care Center: Demographics and Surgical Indications

Corneal pathologies are among the most common reversible sight-threatening diseases globally. As such, corneal tissue transplantation (keratoplasty) techniques are evolving over time depending on the prevalence of different pathologies in each geographical area. We aim to provide a baseline information on the common keratoplasty procedures performed in our area in relation to prevalent corneal pathologies and to analyze common corneal surgical practice trends in our area. Other types of corneal tissue sampling (superficial keratectomy and corneal biopsy) indicated for therapeutic and diagnostic purposes are also included.

This is a retrospective cohort study. All corneal tissue specimens, including those harvested for both therapeutic and diagnostic purposes, received for histopathological examination at our center over a period of 5 years were collected along with the respective demographic data, clinical diagnoses, and surgical indications. Descriptive analysis was used to elucidate important conclusions, and comparative analysis was used to highlight differences between different types of keratoplasty specimens in relation to the surgical indications.

A total of 347 patients' corneal tissue specimens were included. Males accounted for 52.45%. Full-thickness corneal buttons were the most common (n = 172), followed by partial-thickness corneal specimens (n = 75), and Descemet's membrane and endothelium samples (n = 63). Top surgical indications for keratoplasty were keratoconus (n = 149), followed by bullous keratopathy (n = 61), failed previous keratoplasty (n = 47), corneal ulceration (n = 33) and corneal dystrophies (n = 22). Patients undergoing penetrating or lamellar keratoplasty were significantly younger (p < 0.001). Superficial keratectomy and corneal biopsy for keratitis were significantly more common among male patients (p = 0.041), while failed endothelial keratoplasty was observed more among females (p = 0.026).

Our findings highlight the evolving landscape of corneal transplantation and the importance of tailoring surgical approaches to address the specific needs and risk profiles in different populations. Keratoconus is a leading cause for corneal grafting and seems to constitute a major treatable and visually disabling disease in Saudi Arabia, thus may require further screening and genetic studies with consideration for preventive measures.