Validation of tissue quality parameters for donor corneas,designated for emergency cases: corneal graft survival

Purpose: To validate tissue quality parameters for donor corneas designated for emergency grafting for corneal graft survival. Methods: In a longitudinal cohort follow‐up study, 131 emergency penetrating grafts were studied. Grafts were performed with a pool of organ‐cultured donor corneas designated for emergency grafting and prepared for immediate use with all safety tests performed. Assignation criteria were: corneas with a small superficial stromal opacity but meeting all selection criteria for PKP tissue and corneas without stromal opacity, but an endothelial cell density from 1800 to 2300 cells/mm² or mild polymegathism or pleomorphism. Cox multivariate regression analysis, Kaplan–Meier survival and log rank test were applied. Results: Of the 131 keratoplasties, 115 could be followed. One eye was lost during surgery because of an expulsive bleeding. In 15 cases, a conjunctival transplantation finished off the penetrating graft. Corneal graft survival was not significantly related to the presence of PKP quality of the donor endothelium, neither with a cloudy graft nor with endothelial decompensation as the cause of failure. Main risk factors for a failed graft were vascularization of the host cornea (p = 0.0001), the presence of a systemic auto immune disease in the recipient (p = 0.003) and the disease leading to the (imminent) perforation and emergency graft (p = 0.021). Conclusion: A selected pool of donor corneas designated for emergency grafting that does not interfere with the scheduled procedures allows more efficient and safe use of donor tissue in case of a(n) (imminent) perforation. Corneal graft survival rates justify the criteria for selection.