Keratoplasty in the United States: Trends and Indications From 2015 to 2020

Purpose: The aim of this study was to report trends in keratoplasty techniques and indications in the United States from 2015 to 2020. Methods: This retrospective review of annual reports from the Eye Bank Association of America assessed domestic corneal graft distribution and surgical indication data for various types of keratoplasty. Trends in procedure volume and indications from 2015 to 2020 were analyzed using the Cochran–Armitage test. Results: The total number of corneal transplants increased from 47,903 in 2015 to 49,143 in 2019, with a decline to 42,257 in 2020, most likely due to COVID-19. Penetrating keratoplasty (PK) volume decreased from 2015 to 2020 (19,160–15,402, 40% to 36.4%, P < 0.001), continuing a trend from the previous decade. Descemet membrane endothelial keratoplasty as a percentage of all keratoplasty procedures increased (9.8%–27.8%, P < 0.001), whereas Descemet stripping automated endothelial keratoplasty (47%–33.9%, P < 0.001) and anterior lamellar keratoplasty (ALK) decreased (2.3%–1.2%, P < 0.001). From 2017 to 2020, repeat corneal transplant was the most common specific indication for PK while ectasias/thinnings decreased in prevalence (15.6%–11.5%, P < 0.001). Ectasias/ thinnings and endothelial dystrophy remained the leading indications for ALK and endothelial keratoplasty, respectively. Conclusions: From 2015 to 2020, keratoplasty trends in the United States showed a continuation of the decrease in PK and increase in Descemet membrane endothelial keratoplasty observed in the previous decade. The most common domestic indications from 2017 to 2020 have been repeat corneal graft, endothelial dystrophy, and ectasias/thinnings for PK, EK, and ALK, respectively.