Changing Indications for Penetrating Keratoplasty in Bahrain in a Tertiary Referral Centre

Purpose: To study the changing indications for Penetrating keratoplasty in Bahrain and to compare them with published data. Patients and Methods: A Retrospective review of available records of patients who underwent penetrating keratoplasty at a tertiary center in Bahrain (1996-2015). The trend of each indication was analyzed. The study was subdivided into three periods for correlation purposes. Pearson Coefficient r and the p values were used for interpretation of data. The results were compared with similar studies. Results: A total of 298 patients underwent keratoplasty in the study period, which is from 1996 until 2015 (missing data 2009-2011). Keratoconus was found to be the leading indication, accounting for 33% of the total cases, followed by trachoma 27%, followed by aphakic and pseudophakic bullous keratopathies 13%. Trachoma showed a statistically significant decreasing trend (p < 0.001), Keratoconus had an increasing trend (p<0.001). Bullous keratopathy showed an increasing trend (p = 0.001) with an abrupt rise after 2012. Conclusion: Corneal scarring due to old trachoma was the leading indication for keratoplasty 20 years ago in Bahrain. However, due to improvement of health awareness, hygiene, and the socioeconomic status, this has regressed with keratoconus becoming the leading indication from 2002 onwards. A surge of bullous keratopathy was noted after 2012, placing it as the second commonest indication. This may be due to the introduction of phacoemulsification technique for cataract surgery, and perhaps because the nature of the institute being a teaching hospital. Keratoconus is the leading indication and showed an increasing trend. It is recommended to perform a keratoconus screening program for early detection and prevention.