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Risk Factors for Donor Endothelial Loss in Eye BankPrepared Posterior Lamellar Corneal Tissue for Descemet Stripping Automated Endothelial Keratoplasty

Liu, Yu-Chi MD*,†; Alvarez Paraz, Carisa M. MD; Cajucom-Uy, Howard Yu MD*,†; Agahari, Djoni BDS; Sethuraman, Selvam BSc; Tan, Donald T.-H. FRCS*,†,‡,§; Mehta, Jodhbir S. FRCS*,†,¶

doi: 10.1097/ICO.0000000000000150
Clinical Science

Purpose: The aim of this study was to investigate donor, tissue, and precut procedure risk factors for endothelial cell density (ECD) loss in posterior lamellar corneal tissue preparation by an eye bank for Descemet stripping automated endothelial keratoplasty.

Methods: A total of 259 corneoscleral rims precut by the Singapore Eye Bank from October 2011 to August 2013 were evaluated. Donor characteristics, tissue characteristics, and precut procedure parameters were analyzed.

Results: The mean donor age was 57.18 ± 11.35 years, and the mean cutting transition time was 4.16 ± 0.75 seconds. The mean ECD was 2826 ± 225 and 2787 ± 224 cells per square millimeter before and after precutting, respectively, with an average ECD change of −1.38% ± 3.28%. The precutting procedure failure rate was 1.2%. Mutivariate regression analysis showed that an older donor age, a higher ECD before cutting, and a slower cutting transition speed were significant factors. Corneas with an ECD >2800 cells per square millimeter before precutting, cutting transition time >5.5 seconds, and corneas with donor age >65 years were significantly more likely to have greater than 5% ECD loss after precutting (odds ratio, 6.42, 1.66, and 1.62; 95% confidence interval, 1.44–29.43, 1.45–2.72, and 1.66–5.82, respectively). Donor source, death-to-preservation time (range, 0.67–10.88 hours), death-to-precutting time (range, 0–7 days), and graft thickness (range, 43–232 μm) were not statistically significant factors.

Conclusions: The ECD loss in the precut tissue prepared by the eye bank was very low. The risk factors identified provide better understanding of how to improve the quality and safety profiles when preparing graft tissue for Descemet stripping automated endothelial keratoplasty.

*Singapore Eye Research Institute, Singapore, Singapore;

Singapore National Eye Centre, Singapore, Singapore;

Department of Ophthalmology, Yong Yoo Lin School of Medicine, National University of Singapore; Singapore, Singapore;

§Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; and

Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore.

Reprints: Jodhbir S. Mehta, FRCS, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received March 10, 2014

Accepted April 08, 2014

© 2014 by Lippincott Williams & Wilkins.