Endothelial keratoplasty practice patterns in Canada

Authors: Eli Kisilevsky, Divya Srikumaran, Hall Chew.

Disclosure Block: E. Kisilevsky: None. D. Srikumaran: None. H. Chew: None.

Abstract Title: Endothelial keratoplasty practice patterns in Canada

Abstract Body:

Purpose: To quantify practice patterns of endothelial keratoplasty in Canada and assess attitudes towards and barriers to performing Descemet Membrane Endothelial Keratoplasty (DMEK).

Study Design: Prospective cohort study.

Methods: An anonymous online survey was distributed via email to all corneal surgeons included in the Canadian Ophthalmological Society database between February and April 2020. Study was approved by the University of Toronto institutional review board and adhered to the tenets of the declaration of Helsinki.

Results: Of 70 listed surgeons, 41 responses were collected (59% response rate). Most respondents were practicing in university hospitals (44%) or private practice (44%) and were involved in residency teaching (75%). Most respondents performed DMEK surgery (78%) and most surgeons prepared their own grafts (62%). Compared to surgeons <25 years in practice, surgeons in practice >25 years were less likely to perform DMEK (13% vs 75%, p=0.011) and performed fewer corneal transplantations in the previous year (mean 28 vs. 44, p=0.022). Those not performing DMEK reported access to pre-prepared tissue (77.8%), access to wet lab courses (44%) and assistance or mentorship (44%) as common facilitators to performing DMEK surgery.

Conclusions: DMEK is the preferred surgery for endothelial disease among Canadian corneal surgeons. Eye banks play a key role in increased adoption by ensuring an adequate supply of tissue and tissue preparation for surgeons to feel confident to perform DMEK. Ensuring adequate supply of donor tissue and supplementary surgeon training can ensure that DMEK surgery is widely available in Canada.