Changing indications for penetrating keratoplasty: Histopathology of 1,250 corneal buttons

To analyze recent trends in the indications for penetratin,keratoplasty. Methods. After keratoplasty, 2,557 corneal buttons were sent to and analyzed in the ophthalmopathology laboratory of the University of Erlangen-Nurnberg, Erlangen, Germany, between 1992 and 1996. Of these, 1,250 random corneal buttons were evaluated in this study. Results. Histopathologic diagnoses were (a) keratoconus (20.9%), (b) corneal scarring after keratitis/trauma (20.4%), (c) pseudophakic/aphakic bullous keratopathy (17%), (d) regraft (15.5%), (e) Fuchs' corneal endothelial dystrophy (14.9%), (f) necrotizing/ulcerative keratitis (5.3%), and (g) corneal dystrophies (1.7%). Conclusion. Compared with a previous report from our laboratory (1964-1986), the relative frequencies of pseudophakic/aphakic bullous keratopathy, regraft, and Fuchs' dystrophy increased, whereas corneal scarring decreased. Keratoconus is now the most frequent indication for penetrating keratoplasty.