[Status of and indications for keratoplasty in Madagascar]

Corneal diseases, with various aetiologies, are a major cause of visual impairment and blindness in developing countries. According to the World Health Organization (WHO), they are among the top five causes of blindness worldwide. However, performing a keratoplasty can restore vision.

This retrospective descriptive study was conducted at the Ophthalmology department of the CHU-JRA. It focused on 192 patients who were indicated for corneal transplantation over a period of 8 years. The demographic profile, surgical indications, and surgical techniques were evaluated.

The main indication was advanced-stage keratoconus in 48% of cases, with an average age of 21±9.2 years, followed by corneal opacities due to traumatic or infectious sequelae in 31.25% of cases, and bullous keratopathy in pseudophakic patients in 11% of cases. Among the 192 patients indicated for keratoplasty, 46% had already undergone corneal transplantation by penetrating keratoplasty. Keratoconus was the most common indication for these patients (74%). For the 54% who had not yet been operated on, keratoconus was present in 25% of cases, followed by corneal opacities due to sequelae in 49% of cases. In this waiting group, older subjects predominated, with an average age of 33.51±21.02 years.

Keratoconus remains the main indication for corneal transplantation in Madagascar, followed by corneal scars and bullous keratopathy. Improving healthcare infrastructure, strengthening specialist training, and establishing a legislative framework for corneal transplants are essential to meet the growing needs in Madagascar.