Does lamellar surgery for keratoconus experience the popularity it deserves?

Purpose To analyse developments in surgical treatment for keratoconus (KC) by assessing rates and types of corneal surgery from 2005 to 2010. Methods The Dutch Transplantation Foundation supplied data on all keratoplasty procedures for KC performed from 2005 to 2010 in the Netherlands. Registration was carried out by the eyebank at allocation and by the surgeon at the time of surgery. The type of surgery was categorized as either a penetrating or a lamellar procedure. Results Five hundred and seventy‐five anonymized records were received, with excellent data completion (99%). Patients undergoing penetrating surgery had on average a lower visual acuity, higher k‐readings and were slightly older compared with the lamellar group. A previous corneal hydrops was recorded for 19.1% of patients. Regular penetrating keratoplasty decreased in popularity from 79.7% in 2005 to 43.7% in 2010, due to the increased rate of lamellar surgery (42.5% in 2010) and ‘mushroom’ penetrating keratoplasty (13.8% in 2010). When hydrops cases were excluded, popularity became equal (47.6% penetrating versus 52.4% lamellar surgery, in 2010). Conclusion Lamellar surgery is gaining in popularity, although regular penetrating keratoplasty is still the more commonly performed procedure. Only when hydrops cases are excluded do transplant rates become comparable.