Indications for penetrating keratoplasty in Canada, 1986-1995

To examine the leading indications for penetrating keratoplasty.

We retrospectively performed a chart review of 904 cases of penetrating keratoplasty over a 10-year period (1986-1995). Where possible, the clinical indication was corroborated by the pathological report.

Leading indications included pseudophakic bullous keratopathy (PBK; 28.5%), regraft (22.4%), keratoconus (10.0%), Fuchs' dystrophy (7.6%), aphakic bullous keratopathy (ABK; 6.1%), herpetic keratopathy (4.2%), bacterial infection (4.2%), physical trauma (4%), interstitial keratitis (3.7%), and corneal scarring (2.8%). The most common type of intraocular lens found in patients with PBK was the anterior-chamber lens [AC IOL, 71.6%; posterior-chamber lens (PC IOL), 16%; iris-plane IOL (IP IOL; 12.5%]. In our series, we noted decreasing trends in the incidences of ABK (p < 0.001) and PBK (p < 0.04) and an increasing trend in the incidence of regraft (p < 0.0083). Our data do not show statistically significant changes in the incidences of Fuchs' dystrophy and keratoconus. Gender differences were present for Fuchs' dystrophy with female exceeding male patients by a 3:1 ratio (p < 0.001). Male exceeded female patients by 2:1 for keratoconus (p < 0.001). Male exceeded female patients by 3:1 for trauma (p < 0.001).

In this series, the leading indications for penetrating keratoplasty were found to be generally in agreement with the data reported in recent literature. Variations may reflect the wide variations in practice and referral patterns.