Nineteen years of penetrating keratoplasty in the Hotel-Dieu Hospital in Paris

Purpose. To identify changing trends in penetrating keratoplasties (PKs) pe rformed at the Hotel-Dieu Hospital in Paris between January 1980 and Decemb er 1999 and to explain the reasons for the changes. Methods. We retrospecti vely reviewed 3,736 of the 3,836 PKs performed between January 1, 1980, and December 3 1. 1999, and classified them into diagnostic categories. Result s. The most common indications for PK were keratoconus (28.8%), herpetic in fections (10.9%), graft failures (9.9%), aphakic and pseudophakic corneal e dema (9.9%), Fuchs' endothelial dystrophy (9.4%), and nonherpetic leucoma ( 7.7%). Other indications represented 23.4% of the cases. The incidence of a phakic and pseudophakic corneal edema progressively increased between 1980 and 1991, became the most frequent indication in 1991 (21.4%), and then pro gressively decreased. The annual number of PKs increased between 1980 and 1 986, decreased between 1987 and 1997, and increased again after September 1 997. The decrease was caused by both a shortage of corneal buttons, and, in 1987, the fear of transmitting diseases through corneal transplantation, p articularly human immunodeficiency virus. Beginning in 1992, decreases were also associated with stringent governmental regulations of eye bank tissue . Conclusion. Changes in the incidence and management of corneal disorders were the primary factors leading to modifications of grafting until 1987. A fter 1987, corneal button shortage probably corresponded to the acquired im mune deficiency syndrome epidemic, Governmental regulations of eye banking led to a severe corneal button shortage between 1992 and 1997. Despite an i ncrease in the number of PKs performed after 1997, corneal buttons are stil l preferentially allocated to patients in whom there is a high probability of graft success.