[Keratoplasty in Germany: Systematic Analysis of the Quality Reports of German Hospitals between 2006 and 2017].

Abstract:

BACKGROUND:Keratoplasty is considered the most frequently performed type of transplantation in humans. Traditionally, penetrating keratoplasty has been the most common procedure. However, over the last 15 years, the importance of posterior lamellar keratoplasty has increased for the treatment of Fuchs endothelial dystrophy and bullous keratopathy. In Germany, based on national surveys, it was suggested that there was a trend towards lamellar keratoplasty. OBJECTIVE:The main objective of this study was to determine whether the proportion of lamellar keratoplasties carried out in Germany between 2006 and 2017 had increased. Furthermore, the number of keratoplasties carried out as HLA-matched (HLA: human leukocyte antigen) keratoplasties should be calculated. MATERIALS AND METHODS:The numbers of all keratoplasties carried out as lamellar/penetrating and HLA-matched keratoplasties was extracted from the hospital quality reports published between 2006 and 2017. Descriptive statistical analysis was carried out in R (www.r-project.org). RESULTS:Between 2006 and 2017, 43,021 keratoplasties were carried out in Germany. The number of keratoplasties increased from 2,849 (2006) to 8,231 (2017). The number of penetrating keratoplasties remained stable. The proportion of lamellar keratoplasties increased from 6.5% (2006) to 61.4% (2017). The proportion of HLA-matched keratoplasties was below 20% and declined between 2010 and 2017 (2010: 19.7%; 2017: 9.8%). DISCUSSION:In Germany, posterior lamellar keratoplasty has become increasingly important. Since 2014, the number of lamellar keratoplasties has exceeded the number of penetrating keratoplasties. However, the number of penetrating keratoplasties remained stable between 2006 and 2017 and still plays an important role in the management of patients with predominantly stromal or corneal defects affecting all layers. The decreasing number of HLA-matched keratoplasties is most likely due to the lack of clear evidence of a significant reduction in the rejection rates in cases of normal risk keratoplasty. HINTERGRUND:Die Keratoplastik zählt weltweit zu den am häufigsten durchgeführten Gewebetransplantationen. Traditionell entfiel die überwiegende Mehrheit der Eingriffe auf die perforierende Keratoplastik. Mit deren Weiterentwicklung in den vergangenen 15 Jahren gewann jedoch insbesondere die posteriore lamellierende Keratoplastik zur Behandlung der Fuchs-Endotheldystrophie sowie der bullösen Keratopathie zunehmend an Bedeutung. Basierend auf informellen Umfrageergebnissen wurde postuliert, dass sich auch in Deutschland ein Trend hin zur posterioren lamellierenden Keratoplastik abzeichnet. ZIEL DER ARBEIT:Anhand der Qualitätsberichte der Krankenhäuser sollte geprüft werden, ob der Anteil der lamellierenden Keratoplastik in Deutschland im Zeitraum 2006 bis 2017 zugenommen hat. Zudem sollte die Zahl der HLA-kompatibel (HLA: humanes Leukozytenantigen) durchgeführten Keratoplastiken ermittelt werden. MATERIAL UND METHODEN:Die Operationszahlen der perforierend/lamellierend bzw. HLA-kompatibel durchgeführten Keratoplastiken wurden anhand der OPS-Ziffern aus den Krankenhausqualitätsberichten der Jahre 2006 bis einschließlich 2017 extrahiert. Die deskriptive statistische Auswertung erfolgte mit dem Softwarepaket R (www.r-project.org). ERGEBNISSE:Von 2006 bis 2017 wurden deutschlandweit insgesamt 43 021 Keratoplastiken durchgeführt. Die Zahl der durchgeführten Keratoplastiken stieg von 2849 im Jahr 2006 auf 8231 im Jahr 2017. Die absolute Zahl perforierender Keratoplastiken blieb insgesamt konstant. Der relative Anteil lamellierender Keratoplastiken stieg von 6,5% (2006) auf 61,4% (2017) an. Die Zahl der HLA-kompatibel durchgeführten Keratoplastiken lag stets unter 20% und war ab 2010 rückläufig (2010: 19,7%; 2017: 9,8%). DISKUSSION:Die posteriore lamellierende Keratoplastik hat auch in Deutschland stark an Stellenwert gewonnen und seit 2014 die perforierende Keratoplastik als häufigste Form der Keratoplastik abgelöst. Die perforierende Keratoplastik, deren absolute Zahl über den gesamten Untersuchungszeitraum insgesamt konstant blieb, hat jedoch nach wie vor einen hohen Stellenwert bei der Behandlung von vorwiegend stromalen oder durchgreifenden Hornhautdefekten. Der Anteil HLA-kompatibler Keratoplastiken hat vermutlich insbesondere vor dem Hintergrund fehlender eindeutiger Nachweise einer Verringerung der Abstoßungsraten in Standardsituationen in den letzten Jahren weiter abgenommen.

journal_name

Klin Monbl Augenheilkd

authors

Daniel MC,Böhringer D,Lapp T,Maier PC,Reinhard T,Lang SJ

doi

10.1055/a-1035-9442

subject

Has Abstract

pub_date

2020-01-22 00:00:00

eissn

0023-2165

issn

1439-3999

pub_type

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