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Changing trends in keratoplasty: a 20-year analysis from a tertiary referral center in Türkiye
Ali Safa Balci1, Ahmet Kirgiz2, Berra Altindis2
1Department of Ophthalmology, University of Health Sciences, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Emek Neighbourhood, Namik Kemal St. No:54, 34785, Sancaktepe/Istanbul, Turkey. alisafabalci@gmail.com.
Purpose:
To evaluate changes in keratoplasty indications and surgical techniques over a 20-year period at a tertiary referral center in Türkiye.
Methods:
This retrospective study included patients who underwent corneal transplantation between January 2006 and December 2025. Patient demographics, surgical indications, and keratoplasty techniques were collected. Surgical procedures were categorized as penetrating keratoplasty, lamellar keratoplasty. The study period was divided into four consecutive 5-year intervals. Changes in keratoplasty indications were analyzed using the chi-square test. Changes in surgical technique over time were evaluated using binary logistic regression, with lamellar keratoplasty assessed relative to penetrating keratoplasty.
Results:
A total of 3281 keratoplasty procedures were performed in 2593 patients. The most common indications were keratoconus (23.0%), pseudophakic bullous keratopathy (22.5%), regraft (18.7%), leukoma (16.0%), and endothelial corneal dystrophy (4.9%). The distribution of indications differed significantly across study periods (p < 0.001). The proportion of keratoplasty performed for keratoconus decreased over time, whereas pseudophakic bullous keratopathy and regraft procedures increased. A shift in surgical technique was observed, with a progressive increase in lamellar keratoplasty. Across successive 5-year periods, the odds of lamellar keratoplasty increased by 1.59-fold relative to penetrating keratoplasty. This increase was more pronounced in pseudophakic bullous keratopathy, while the trend in keratoconus was present but more gradual.
Conclusion:
This study demonstrates significant changes in keratoplasty indications and surgical techniques over two-decades. The proportion of keratoplasty performed for keratoconus declined, while pseudophakic bullous keratopathy and regraft became more frequent. Lamellar keratoplasty was increasingly preferred over time, reflecting evolving surgical practice in a tertiary setting.
