Indications for penetrating keratoplasty in a tertiary referral centre in Canada, 1996-2004

Background: The leading indications for penetrating keratoplasty (PKP) have changed over recent years. This study examined the leading indications for PKP and their trends, comparing these with recently published data from other studies, including a report from our centre examining indications from 1986 through 1995. Methods: A retrospective chart review was conducted of all patients who underwent PKP in a single practice at the University Health Network,Toronto Western Hospital, between July 1, 1996, and June 30, 2004. Results: A total of 617 patients underwent 794 PKP operations during the 8-year study period. Sufficient documentation was available to include 777 surgeries from 600 patients in this study. Specific indications for PKP were reported and grouped into 16 categories. The leading indication categories for PKP were regraft (209 cases, 26.9%), pseudophakic bullous keratopathy (PBK) (193 cases, 24.8%), primary corneal endotheliopathies including Fuchs' endothelial dystrophy (101 cases, 13.0%), anterior keratoconus (93 cases, 12.0%), and viral or postviral causes (41 cases, 5.3%). Regraft, keratoconus, and Fuchs' endothelial dystrophy each displayed a nonsignificant decreasing trend from 1996 to 2004, and PBK, herpes simplex virus, and mechanical trauma each displayed a nonsignificant increasing trend (p > 0.05 for all). Interpretation: Regraft was the leading indication for PKP at our centre, followed by PBK; these findings were in agreement with data reported in recent literature. The frequency of regraft had increased since a previous study from our centre (1986-1995), and the frequency of PBK had decreased.