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Effect of Donor Graft Quality on Clinical Outcomes After Deep Anterior Lamellar Keratoplasty

Feizi, Sepehr MD, MSc; Javadi, Mohammad A. MD; Kanavi, Mozhgan R. MD; Javadi, Fatemeh MD

doi: 10.1097/ICO.0000000000000177
Clinical Science

Purpose: The aim of this study was to determine the effect of donor features, including age, death-to-preservation time, preservation-to-surgery time, graft rating, and endothelial cell features, on visual and refractive outcomes and complications occurring after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.

Methods: In this retrospective study, 290 consecutive keratoconic eyes underwent DALK using donor corneas of different qualities, ranging from fair to excellent. Donor corneas were stored in intermediate-term storage medium. Donor data included age and sex, death-to-preservation time, preservation-to-surgery time, epithelial and stromal status, endothelial cell density and morphology, and graft rating. Postoperative outcomes included visual acuity, refractive error, epithelial problems, suture-related complications, graft rejection, and graft transparency. A multivariate regression analysis was used to assess the correlation between donor characteristics and postoperative outcomes.

Results: Mean donor and recipient ages were 33.4 ± 13.1 and 27.7 ± 8.0 years, respectively. The mean follow-up period was 38.2 ± 20.2 months. The presence of epithelial defects on postoperative day 1 had a significant correlation with donor epithelial sloughing (R = 0.26, P < 0.001), preservation-to-surgery time (R = 0.21, P = 0.001), and graft rating (R = −0.17, P = 0.004). Graft stromal edema on postoperative day 1 was significantly correlated with donor epithelial sloughing (R = 0.31, P < 0.001), preservation-to-surgery time (R = 0.24, P < 0.001), and graft rating (R = −0.28, P < 0.001). Suture-related complications, graft rejection episodes, graft clarity, visual acuity, and refractive outcomes at the final follow-up examination were found to have no correlations with any donor factors.

Conclusions: The use of low-quality donors for DALK increased the rate of epithelial defects and stromal edema immediately postoperatively. However, the donor features had no influence on visual and refractive outcomes and complications.

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

Reprints: Sepehr Feizi, MD, MSc, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Ave, Tehran 16666, Iran (e-mail:

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

Received February 01, 2014

Accepted May 03, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.