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Graft Epithelial Defects After Deep Anterior Lamellar Keratoplasty

Feizi, Sepehr MD, MSc; Javadi, Fatemeh MD; Javadi, Mohammad Ali MD

doi: 10.1097/ICO.0000000000000239
Clinical Science

Purpose: The aim of this study was to report the incidence of epithelial defects and identify donor factors that might correlate with the presence of epithelial defects and graft reepithelialization time after a deep anterior lamellar keratoplasty (DALK).

Methods: In this retrospective study, 283 consecutive keratoconic eyes underwent DALK using donor corneas of different qualities, ranging from fair to excellent. The donor data included age and sex, cause of death, death-to-preservation time, preservation-to-surgery time, epithelial and stromal status, endothelial cell density and morphology, and graft rating. On the first postoperative day, the corneal surface was carefully examined before and after the application of fluorescein stain, and the patients were followed up daily until complete reepithelialization occurred. A multivariate regression analysis was used to assess the correlation between donor characteristics and graft epithelial defects on postoperative day 1.

Results: The mean donor and recipient ages were 33.5 ± 13.2 and 27.6 ± 7.9 years, respectively. Two hundred sixty-four (93.3%) grafts had epithelial defects on day 1. The epithelial defects completely healed after 3.5 ± 2.7 (range, 1–37) days. In the univariate analysis, the presence of epithelial defects on postoperative day 1 had a significant correlation with donor preservation-to-surgery time (P = 0.01), epithelial sloughing (P < 0.001), and graft rating (P = 0.004). In the multivariate analysis, only donor epithelial sloughing significantly influenced the presence of epithelial defects on postoperative day 1 (odds ratio = 9.26, P < 0.001).

Conclusions: Graft epithelial defects were very common after DALK. The epithelial status of donors was the only independent factor predictive of the surface integrity on the first postoperative day.

Department of Ophthalmology, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Reprints: Mohammad Ali Javadi, MD, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran 16666, Iran (e-mail:

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

Received June 13, 2014

Received in revised form July 03, 2014

Accepted July 04, 2014

© 2014 by Lippincott Williams & Wilkins.