1 Department of Ophthalmology, University of Cologne, Cologne, Germany. 2 Department of Ophthalmology, RWTH Aachen University, Aachen, Germany. 3 Department of Medical Informatics Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany. 4 Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD.
Transplantation. 2017 Jun;101(6):1387-1399. doi: 10.1097/TP.0000000000001281.
Penetrating keratoplasty (PK) ranks among the oldest and most common kinds of human tissue transplantation. Based on the hypothesis that reported indications for PK significantly vary between global regions and over time, the present systematic review aimed to provide a thorough overview of global PK indications as reported in peer-reviewed manuscripts.
A literature search of PubMed and MEDLINE was conducted to retrieve articles published from January 1980 to May 2014. Indications for PK within 7 global regions were compared using a modified classification system for PK indications and analyzed via multivariate regression.
A total of 141 publications from 37 countries were included, recording 180 865 PK cases. Postcataract surgery edema was the predominant indication in North America (28.0%) and ranked second in Europe (20.6%), Australia (21.1%), the Middle East (13.6%), Asia (15.5%), and South America (18.6%). Keratoconus was the leading indication in Europe (24.2%), Australia (33.2%), the Middle East (32.8%), Africa (32.4%), and South America (22.8%). It ranked third in North America (14.2%). Keratitis was the primary indication in Asia (32.3%). Fuchs endothelial corneal dystrophy was the fourth most common indication in North America (12.9%) and Europe (10.2%) and fifth in South America (3.8%). Multivariate analysis supported these results and revealed individual regional changes over time.
Systematic analysis reveals characteristic chronological and regional differences in reported global PK indications. Leading reported indications for PK between 1980 and 2014 were keratoconus (Europe, Australia, the Middle East, Africa, and South America), pseudophakic bullous keratopathy/aphakic bullous keratopathy (North America), and keratitis (Asia).
穿透性角膜移植术（PK）是最古老、最常见的人类组织移植之一。基于报道的 PK 适应证在全球不同地区和时间显著变化的假说，本系统综述旨在提供同行评议文献中报道的全球 PK 适应证的全面概述。
对 PubMed 和 MEDLINE 进行文献检索，检索 1980 年 1 月至 2014 年 5 月发表的文章。使用改良的 PK 适应证分类系统比较 7 个全球区域的 PK 适应证，并通过多变量回归进行分析。
共纳入来自 37 个国家的 141 篇文献，记录了 180865 例 PK 病例。北美以白内障术后水肿为主要适应证（28.0%），在欧洲（20.6%）、澳大利亚（21.1%）、中东（13.6%）、亚洲（15.5%）和南美洲（18.6%）中排名第二。圆锥角膜是欧洲（24.2%）、澳大利亚（33.2%）、中东（32.8%）、非洲（32.4%）和南美洲（22.8%）的主要适应证。在北美排名第三（14.2%）。角膜炎是亚洲（32.3%）的主要适应证。真菌性角膜溃疡是北美（12.9%）和欧洲（10.2%）的第四大常见适应证，在南美洲（3.8%）排名第五。多变量分析支持这些结果，并揭示了随时间的个体区域变化。
系统分析揭示了报告的全球 PK 适应证的特征性时间和区域差异。1980 年至 2014 年报告的 PK 主要适应证为圆锥角膜（欧洲、澳大利亚、中东、非洲和南美洲）、白内障术后囊泡性角膜病变/无晶状体性囊泡性角膜病变（北美）和角膜炎（亚洲）。
