Trends in the indications for penetrating keratoplasty in the midwestern United States

Purpose. To examine the leading indications and identify the changing trend s for penetrating keratoplasty (PKP) in the midwestern United States. Metho ds. The indications for PKPs at a single center tertiary care referral prac tice were tabulated to assess trends from 1982 to 1996. The data analysis w as prospective after 1985. Age, gender, clinical indication for PKP, date o f surgery, status of the lens at the time of surgery (phakic, aphakic, pseu dophakic, cataract), and any secondary diagnoses were recorded. In pseudoph akic eyes, the type of intraocular lens (IOL) present at the time of surger y was noted. Correlation analysis and linear regression were used in the SA S system, version 6.12, to test for the statistical significance in increas ing or decreasing trends over the span of the study. Results. A total of 4, 217 PKPs were performed on 3,263 patients. The leading indication for PKP w as pseudophakic bullous keratopathy (31.5%), with 73% of these cases associ ated with an anterior chamber IOL. 21% associated with a posterior chamber IOL, and 6% associated with an iris-fixated IOL. Fuchs' dystrophy (23.2%), keratoconus (11.4%), corneal scarring (11.2%), failed graft (8.9%), and aph akic bullous keratopathy (7.5%) followed pseudophakic bullous keratopathy i n frequency. These six groups accounted for approximately 93% of all cases performed. There were significant increasing trends in the incidence of fai led grafts (p = 0.0001) and corneal scarring (p = 0.0001), and decreasing t rends in the incidence of aphakic bullous keratopathy (p = 0.0001). There w as a significant decreasing trend in pseudophakic bullous keratopathy from 1989 to 1996 (p = 0.0031). Conclusions. Pseudophakic bullous keratopathy wa s the leading indication for PKP in our series. This is in agreement with t he data reported in other similar studies done in North America. However, u nlike most of these studies, our second leading indication was Fuchs' dystr ophy. This contrast may be secondary to different genetic demographics in t he midwestern United States.