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    Cornea/External Disease

    This study retrospectively analyzed data from the German Keratoplasty Registry to delineate trends in corneal transplantation.

    Study design

    The authors distributed questionnaires to 111 ophthalmologic departments in Germany to ascertain the number of corneal transplants performed between 2001 and 2016, as well as the indications for each procedure.


    Analysis of responses from 94 of the 111 departments revealed that keratoplasties increased by 1.5-fold over the study period, from 4,730 in 2001 to 7,325 in 2016.

    By 2014, lamellar keratoplasties were performed more often than penetrating keratoplasties. In 2016, German surgeons performed 12 times more Descemet's membrane endothelial keratoplasties (DMEKs) than Descemet's stripping endothelial keratoplasties (DSEKs). Throughout the study period, Fuchs endothelial corneal dystrophy remained the most common indication for surgery. The proportion of deep anterior lamellar keratoplasties (DALKs) never exceeded 6% (269 in 2011). Keratoconus was a far less common indication for surgery in Germany than in other European countries.


    A significant portion (15%) of the departments did not complete the questionnaire. The study’s retrospective nature precluded analysis of visual or anatomical outcomes.

    Clinical significance

    This study reveals a dramatic shift to lamellar keratoplasty over the last decade across the world. These findings also highlight the increased prominence of DMEK, which is widely considered to be in its early developmental stages in the US but is commonly performed in nations such as Germany.