Regional trends in corneal transplantation from 2004 to 2015 in France: a 12-year review on indications, technique and waiting period

The aim of this study was to report the 12-year longitudinal trends in regional disparity in terms of indications, techniques and waiting period for corneal transplantation in France from 2004 to 2015. The records of all corneal transplantations performed from 2004 to 2015 in France were retrospectively reviewed by analasing the registry and the territorial organization [divided France into 7 interregional areas of collection and distribution of grafts (IACD)] of the French Biomedicine Agency. A total of 46,658 corneal transplantations were performed between 2004 and 2015. In 2014, there was 65.8 keratoplasties per million inhabitants (10(-6) per capita in France, but there were some regional disparities, from 44.9 x 10(-6) per capita in IACD 2 to 87.2 x 10(-6) per capita in IACD 5. In 2014, IACD 7 performed the highest number of transplantations for keratoconus with 15.7 x 10 - 6 per capita; IACD 5 ranked first for Fuchs endothelial disease and secondary endothelial failure with, respectively, 20.5 x 10(-6) per capita and 21.2 x 10(-6) per capita, and IACD 4 ranked first for graft failure with 17.4 x 10(-6) per capita. All regions over the years began to perform more lamellar keratoplasties (4.3% in 2004 vs 45.2% in 2015) and fewer penetrating keratoplasties (85.8% in 2004 vs 48.2% in 2015). The mean waiting time was 3.4 +/- 5.2 months in France over 12 years, with minimal disparities between regions: all of them under 4 months waiting time in 2015, from 1.4 months for IACD 1-3.8 months for IACD 5. Regional disparities have changed over the years, with a modification of indications, and upgrading surgical techniques for some indications. Some disparities remain, mainly because of the variability in the number and activity of transplantation centres and eye banks. Measures could be taken to minimize these disparities, such as increasing communication between eye banks. The waiting time for keratoplasty decreasing below the 4-month mark is a good indicator of the progress made. Regional disparities have decreased over the years, but some regions remain disadvantaged in terms of needs and access to transplants. Tomorrow's challenge is to identify solutions and adapt the offer to the needs.