Purpose: To identify changing indications for keratoplasty over the last 20 years at a tertiary care eye hospital in a country with rapidly evolving ophthalmic care services.
Methods: A retrospective review was performed of the eye bank records of every patient who received a lamellar or penetrating keratoplasty at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, between January 1, 1983 and December 31, 2002. For each case, the primary surgical indication was identified.
Results: A total of 8318 corneal transplants were performed during this 20-year period. In the first 5 years of the study, the leading indications for corneal transplantation were corneal scarring (52.0%), aphakic/pseudophakic bullous keratopathy (13.5%), corneal degeneration (10.0%), and keratoconus (7.6%). During the last 5 years of the study, the leading indications for corneal transplantation were keratoconus (40.2%), corneal scarring (19.8%), failed corneal transplant (11.3%), and corneal ulceration (10.2%). There was a dramatic increase in the number of transplants performed for keratoconus (441%) and failed corneal transplants (285%) as well as a dramatic decrease in the number of transplants performed for corneal degeneration (-88%) and scarring (-60%) between the first and last 5 years of the study period.
Conclusions: Major changes in the indications for corneal transplantation were related to the introduction and expansion of modern ophthalmic services at a time of rapid socioeconomic development and population growth.