Trends and Characteristics of Corneal Transplantation in South Korea (2021–2023): A Three-Year Analysis of Domestic Survey and Eversight Eye Bank Data

Abstract

Purpose: To investigate current trends in corneal transplantation in South Korea by integrating data from the Korean Ophthalmological Society (KOS) and Eversight Eye Bank, focusing on surgical preferences, donor demographics, and evolving practices between 2021 and 2023. Methods: This retrospective epidemiological study reviewed data from annual KOS surveys of government-registered transplantation centers and records from the Eversight Eye Bank. Surgical categories included penetrating keratoplasty (PKP), anterior lamellar keratoplasty (ALK), Descemet’s stripping automated endothelial keratoplasty (DSAEK), Descemet’s membrane endothelial keratoplasty (DMEK), and keratolimbal allograft (KLA). Variables collected included types of surgery, donor demographics, sources of donor corneas, time from death to corneal preservation, and endothelial cell density (ECD). For endothelial keratoplasty (EK), additional graft-specific parameters were collected, including graft diameter, thickness, preloading status, and loading materials. Results: A total of 2636 corneal transplantations were identified. While PKP remained most commonly performed procedure (49.5% in 2023), the proportion of EK steadily increased. DMEK nearly doubled from 8.4% in 2021 to 15.2% in 2023. The proportion of imported donor tissue rose, reaching 74.5% by 2023. Donor age was significantly higher for DMEK (60.9 ± 6.0 years) than for PKP (48.0 ± 14.1 years) or DSAEK (50.7 ± 12.9 years). There was a clear trend toward greater use of preloaded grafts, smaller diameters, and novel loading techniques. Conclusion: Corneal transplantation in South Korea is shifting toward EK, especially DMEK, driven by limited domestic donations and changes in surgical preferences. These findings highlight the importance of enhancing local donation systems and maintaining robust data infrastructure to guide policy and clinical decision-making.