Outcomes of corneal transplantation in Australia, in an era of lamellar keratoplasty

Widespread adoption of modern lamellar procedures has altered the pattern of practice of corneal transplantation. Herein, we describe recent findings from the Australian Corneal Graft Registry and place these data into an international context. The total number of grafts reported to the Registry has doubled over the past decade. Deep anterior lamellar keratoplasty is increasingly used for keratoconus, while endokeratoplasty has displaced penetrating keratoplasty for Fuchs endothelial dystrophy. Graft survival and visual outcomes for modern lamellar procedures have shown improvement over time. First deep anterior lamellar and penetrating grafts for keratoconus show comparable survival and long-term best-corrected visual acuity is equivalent. Penetrating grafts for Fuchs endothelial dystrophy exhibit significantly better survival than do endokeratoplasties, largely because the latter undergo more early graft failures. However, visual rehabilitation is swifter in surviving endokeratoplasties. Significantly fewer recipients of a deep anterior lamellar graft or endokeratoplasty require spectacle or contact lens correction, compared with penetrating keratoplasty.