Changing indications for keratoplasty during the 2020-2021 SARS-COV-2 pandemic

Abstract

Introduction: The Covid-19 pandemic caused by the SARS-COV-2 virus has led to an exacerbation of chronic somatic and eye diseases and an increase in pathology requiring emergency care, including keratoplasty. The purpose: to analyze the indications for keratoplasty ( KP) performed in one specialized center during the Covid-19 pandemic for 2020–2021 and compare them with those in 2018–2019. Methods: Retrospectively were analyzed 376 КР performed in one center for 2 years from 02.02.2018 to 12.30.2019 (control group) and 391 КР performed from 03.01.2020 to 12.30.2021 (pandemic group, PG). The mean age was М = 53.7 ( SD 14.6) similar in both groups, male dominated–62.5%. All КР were analyzed depending on the purpose of the operation (optical or therapeutic), etiology of pathological process, clinical diagnosis, presence of complications, surgical operations performed simultaneously with keratoplasty. Indications for KP included: keratoconus, hereditary corneal dystrophies ( HCD), bullous keratopathy ( BK), ulcerative-necrotic processes of the cornea ( UNPC) herpetic, microbial (bacterial, fungal, mixed infection), neurotrophic, autoimmune, rosacea etiologies and others. Results: In 2018–2019 were performed 134 (35.6%) optical and 242 (64.4%) therapeutic KP; in 2020–2021–84 (22.5%) and–307 (78.5%) optical and therapeutic KP, respectively. In the PG there is an increase in the number of therapeutic KP from 242 (64.4%) to 307 (78.5%) (p < 0,001). Keratoconus and BK decreased in the PG from 70 to 47 and from 23 to 10 respectively, compared to the control group (p < 0.001). The herpetic UNPC has increased from 43 (17.8%) to 67 (21.8%) and neurotrophic from 32 (13.2%) to 54 (17.6%); (p < 0.01) compared with control. The diff erence between KP bacterial, autoimmune, fungal and rosacea etiologies in two groups was not signifi cant. Corneal ulcers were the main clinical diagnosis for therapeutic KP–82.2% in the control group and 83.4%–in the PG. Complications were in the PG 175 (57.0%) vs 108 (44.6%) in the control group (p < 0.01). Surgical interventions combined with keratoplasty were performed in the PG 48 (15.6%) compared to the control group 27 (11.2%) (p < 0.01). Conclusions: The leading indications for keratoplasty in both compared groups were UNCP with an increase in their number of herpetic and neurotrophic etiology in the pandemic group. There has been an increase in complicated severe corneal pathology during the pandemic, requiring corneal transplantation.