Corneal Cross Linking May Reduce Keratoplasty Rates in Eyes With Keratoconus

Corneal Transplant
Corneal transplant.
Penetrating keratoplasty rates declined from 91.4% to 56.9% between 2006 and 2020 in New Zealand, the report states.

Clinicians in New Zealand still perform penetrating keratoplasty in over 50% of corneal transplants, but advances in phacoemulsification and keratoplasty techniques are changing this trend, according to research published in Cornea. Corneal cross-linking (CXL) may also reduce these keratoplasty rates in eyes with keratoconus. 

Researchers identified trends in the primary indications for keratoplasty, estimated cataract surgery rates, and obtained data for endothelial keratoplasty adoption between January 1991 to January 2020 utilizing  New Zealand National Eye Bank (NZNEB) data.

They found that 6840 corneal transplants occurred during the study duration. Transplants performed per year increased from 2.55 to 6.06/100,000 population/year. The team noted that the number of older adults who received transplants increased, while the number of young adults (aged 20 to 39 years) who received transplants leveled off.

According to the report, regraft became the most common indication for corneal transplant (30.9%) in 2019, and keratoconus was involved in about 28% of cases. Corneal dystrophy was indicated in 18.8% of cases. 

Investigators observed a decline in penetrating keratoplasty between 2006 and 2020 (91.4% to 56.9%). During that time Descemet’s stripping (automated) endothelial keratoplasty increased from 0% to 31% and deep anterior/interior lamellar keratoplasty increased from 2.5% to 9.2%.

The researchers attribute these trends to cataract surgeries with improving phacoemulsification technology, the introduction of endothelial keratoplasty with reduced clinical threshold for surgery, and the use of CXL.

“This study found that the trends in corneal transplantation performed in Aotearoa/NZ over the period January 1991 to January 2020, normalized by NZ population data and isolating for the primary indication, has changed considerably in the past 15 years with the evolution of phacoemulsification and keratoplasty techniques and the development of CXL,” according to the researchers. “The number of transplants being performed per population is increasing, with regraft being the number 1 indication in 2019, surpassing keratoconus.” 

Study limitations included incomplete data on corneal dystrophy types.


Chilibeck CM, Brookes NH, Gokul A, et al. Changing trends in corneal transplantation in Aotearoa/New Zealand, 1991 to 2020: effects of population growth, cataract surgery, endothelial keratoplasty, and corneal cross-linking for keratoconus. Cornea. 2022;41(6):680-687. doi:10.1097/ICO.0000000000002812