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Donor Tissue Selection for Anterior Lamellar Keratoplasty

Borderie, Vincent M. MD, PhD; Sandali, Otman MD; Basli, Elena MD, PhD; Goldschmidt, Pablo PhD; Laroche, Laurent MD

doi: 10.1097/ICO.0b013e318285c8b4
Clinical Science

Purpose: To assess the influence of donor characteristics on the outcome of anterior lamellar keratoplasty (ALK) and to evaluate whether corneal donor tissue considered unsuitable for penetrating or posterior lamellar keratoplasty due to poor endothelial condition may be safely used for ALK.

Methods: Institutional setting. One hundred sixty-six consecutive ALK (166 patients) performed for optical indication in eyes with corneal diseases not involving the corneal endothelium. The main outcome measures were graft survival, early (0–12 months postoperatively) and late (after 12 months) annual endothelial cell loss, and postoperative logarithm of the minimum angle of resolution visual acuity.

Results: The average and extreme values of donor tissue characteristics were: donor age, 70.6 years (range, 28–88 years); organ culture time, 20.9 days (range, 12–35 days); graft endothelial cell density before transplantation, 2047 cells per millimeters (range, 100–3300 cells/mm2); and deswelling time, 2.0 days (range, 1–4 days). The average follow-up time of patients was 48.1 ± 24.8 months (mean ± SD). None of the donor characteristics significantly influenced graft survival or postoperative endothelial cell loss (early and late phase). Donor age >80 years was associated with lower postoperative visual acuity at all postoperative points in time (P < 0.05). At 3 years, the mean logarithm of the minimum angle of resolution visual acuity was 0.44 (20/55) for grafts from donors older than 80 years and 0.25 (20/35) for younger donors. This result was shown to be significant both in univariate and in multivariate analysis.

Conclusions: Grafts from elderly donors should be discarded before ALK. Conversely, donor tissue with poor endothelial cell density (<2000 cells/mm2) is suitable for ALK.

Centre Hospitalier National d'Ophtalmologie des XV-XX, UPMC Univ Paris 06, UMR_S 968, Institut de la Vision, INSERM, U968, CNRS, UMR_7210, Paris, France.

Reprints: Vincent M. Borderie, Centre Hospitalier National d’Ophtalmologie des XV-XX, UPMC Univ Paris 06, UMR_S 968, Institut de la Vision, INSERM, U968, CNRS, UMR_7210, 28 rue de Charenton, 75571 Paris, France (e-mail:

The authors have no conflicts of interest to disclose.

Supported by Pierre & Marie Curie University, Paris, France.

Received September 17, 2012

Accepted December 29, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.