Trends in 18 years of keratoplasty in Europe: insights from the European Eye Bank Association’s data

BACKGROUND/AIMS: To examine trends in corneal transplantation in Europe over an 18-year period from 2007 to 2024 by using data from the annual reports of the European Eye Bank Association (EEBA) regarding transplantation procedure type and quality control parameters in eye banking. METHODS: Data were extracted from annual EEBA reports, and a longitudinal analysis of the categories-type of transplant, storage methods, issuance and contamination rates was conducted. RESULTS: The analysis included 443 237 corneas issued for transplantation from 116 different eye banks across 25 countries. The total number of keratoplasty procedures grew by 108%. A shift towards lamellar procedures was noted. Penetrating keratoplasties decreased from 85% (2007) to 34% (2017). A significant increase in posterior lamellar grafts was seen, reaching 47% in 2017, which were increasingly produced in eye banks. Issuance rates improved over time, with 59% of procured corneas issued for transplantation in 2024. Contamination rates remained low at 1-2% for bacterial and 0.3 to 0.96% for fungal contamination. Comparison with other international studies confirms the observed trend favouring lamellar procedures, while countries with differing socioeconomic conditions deviate from this trend. CONCLUSION: This study provides a comprehensive overview of the shifting landscape of corneal transplantation in Europe, reflecting a move towards lamellar procedures and bank-prepared transplants. These findings align with broader international trends, underscoring the importance of continued advancements in surgical techniques and eye banking practices. Low contamination rates are indicative of already successful procedures in eye banking in Europe, and reports of lower rates warrant further investigation and improvement.