Evolution of Corneal Transplantation at Centro Hospitalar Universitário de São João between 2011 and 2021: Will the Paradigm Change?

Abstract

Introduction: Corneal transplantation is the most frequently performed type of trans- plant worldwide. In the last decade, penetrating keratoplasty (PK) has been replaced by lamellar techniques (LK) in several developed countries, since they are less invasive, with a lower risk of rejection and better functional outcomes. We intended to provide an overview of absolute numbers and trends in the types of and indications for corneal transplantation in our center from 2011 to 2021 and second- arily evaluate the impact of the COVID-19 pandemic on the corneal transplantation profile.
Material and Methods: Retrospective analysis of the patients submitted to corneal transplantation in Centro Hospitalar Universitário de São João (CHUSJ) between January 2011 and De- cember 2021. Demographic variables, surgical indication and type of transplantation were analyzed.
Results: We included 1392 eyes. In 2011, 99.3% of the transplants were PK. The relative frequency of LK increased progressively, especially after 2015, with predominance of the posterior lamellar techniques in the management of corneal endothelial disorders. In 2011, all cases with endothelial pathology were treated with PK. In 2016, LK surpassed PK in the management of this condition, with 37.8% and 21.6% submitted to Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), respectively. In 2021, 52.6% and 26.3% of the cases with endothelial pathology were submitted to DSAEK and DMEK, respectively. The year of 2020 limited the total number of procedures performed (either PK or LK), reaching the lowest number of the last decade (85), given the constraints of the COV- ID-19 pandemic. However, in 2021, there was a 58% increase in the number of transplants com- pared to the previous year.
Conclusion: In the last decade, the number of LK in CHUSJ has been progressively increasing and replacing the PK, which has been surpassed since 2016 for the treatment of en- dothelial pathologies with posterior LK techniques. Therefore, a shift in the paradigm has been achieved in our center, in accordance with the observed in other centers.