Changing indications for lamellar keratoplasty in Shandong, 1993 - 2008.

BACKGROUND: With the advancement of microsurgical techniques, lamellar keratoplasty (LK) has been more valued and performed to treat corneal blindness. This study aimed to evaluate the indications and changing trends for LK during the past 16 years in Shandong Eye Institute, an eye center in China.

METHODS: A total of 1529 eyes, predominantly from male (70.7%) patients undergoing LK between January 1993 and December 2008, were enrolled in this study. Data were collected by reviewing patient medical records for demographic characteristics, clinical diagnosis, laboratory findings and risk factors. Surgical times, initial diagnoses and causes of regrafting were recorded. All LKs were sequentially divided into period 1 (from 1993 to 2000) and period 2 (from 2001 to 2008).

RESULTS: Rural-dwelling patients in this study numbered 1089 (71.2%); in all cases of infectious keratitis, rural patients accounted for 90.5%. The leading indications for LK were infectious keratitis (31.0%), corneal trauma (21.1%), keratoconus (18.7%), corneal dystrophy and degeneration (7.3%), regrafting (7.1%), immunologic disorders (6.7%), congenital abnormalities and corneal tumor (4.1%) and corneal scarring (3.1%). The most common subcategory of infectious keratitis was fungal keratitis (67.5%). Fusarium solani was the most morbigenous fungi. Among the patients, 73.1% of thermal burns were caused by hot molten metal, and 47.8% of alkali burns by lime. Dermoid was the most common indication for congenital abnormalities. The two main initial diagnoses from 109 regrafting cases were corneal trauma (45.9%) and Mooren's ulcer (27.5%). The most common cause for regrafting was immune rejection (35.8%). Infectious keratitis was the most common indication for LK from 16.0% in period 1 to 41.1% in period 2, followed by keratoconus (16.8%) and corneal trauma (14.5%).

CONCLUSIONS: During the past 16 years, there have been major changes in the constituent ratios of leading indications for LK in Shangdong. Infectious keratitis has become the most common indication for LK. Fungal keratitis was the most common subcategory of infectious keratitis.