Trends in indications for corneal graft and surgical techniques of transplantation in Iran were designated.

All eye bank records of patients who had undergone corneal transplantation between 2006 and 2013 in Iran were reviewed.

During this 8-year period, a total of 47,129 cases underwent corneal transplantation at ophthalmic centers throughout the country. The most common indication for corneal transplantation was keratoconus (KCN, n=21350, 45.3%), followed by pseudophakic/aphakic bullous keratopathy (PBK/ABK, n=8566, 18.2%), corneal opacity and scar (COS, n=7158, 15.2%), re-graft (n=3252, 6.9%), corneal dystrophies (n=2553, 5.4%), and keratitis (n=2238, 4.7%). There was an increasing trend in rates of PBK/ABK (P=0.001) and re-graft (P=0.025); and a decreasing trend in rate of COS (P=0.012) over this period. No significant change of trend was noted in the rate of KCN (P=0.172), keratitis (P=0.107), and corneal dystrophies (P=0.836). The most common technique of corneal transplantation was penetrating keratoplasty (PKP, n=33476, 71.0%), followed by deep anterior lamellar keratoplasty (DALK, n=8363, 17.7%), Descemet’s stripping automated endothelial keratoplasty (DSAEK, n=3516, 7.5%), tectonic (n=1752, 3.7%), and keratolimbal allograft (KLAL, n=19, 0.1%). An increasing trend was noted in rate of DSAEK (P<0.001); however, PKP revealed a decreasing trend (P=0.005) over the 8-year period. No significant change of trend was noted in the rates of DALK (P=o.354), tectonic (P>0.999) and KLAL (P=0.151).

Significant changes in the indications and surgical techniques of corneal transplantation were observed in the last 8 years in Iran. KCN, with no significant change of trend over the last 8 years, was still the leading cause of corneal transplantation in Iran. Although DSAEK demonstrated an increasing trend over this period, PKP despite its decreasing trend was still the most prevalent technique used for corneal transplantation in Iran.