Split cornea transplantation: relationship between storage time of split donor tissue and outcome

Area of Science:

• Ophthalmology
• Corneal Transplantation
• Tissue Engineering

Background:

• Split cornea transplantation offers a solution to donor tissue shortages.
• Evaluating the impact of storage duration on split donor tissue is crucial for optimizing outcomes in keratoplasty.

Purpose of the Study:

• To investigate the correlation between storage time of split donor corneal tissue and patient outcomes following deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK).
• To assess the safety and efficacy of using split donor tissue stored for varying durations in DALK and DMEK procedures.

Main Methods:

• Retrospective analysis of 110 DALK and 110 DMEK cases involving surgically successful split cornea transplantation.
• Split donor tissue storage times (from splitting to grafting and from death to grafting) were analyzed.
• Outcomes including best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complication rates were evaluated at 1 year post-surgery.

Main Results:

• Mean split donor storage times were 35 ± 47 hours for anterior grafts and 21 ± 40 hours for posterior grafts.
• Mean total storage times were 352 ± 108 hours for anterior lamellas and 339 ± 109 hours for posterior lamellas.
• No significant association was found between split or total storage times and 1-year BSCVA, endothelial cell loss, or complication rates for either DALK or DMEK.

Conclusions:

• Split donor corneal tissue can be safely stored in organ culture for up to one week prior to DALK and DMEK.
• This finding supports the clinical feasibility of split cornea transplantation, potentially alleviating donor shortages and reducing costs.
• Extended storage periods within the tested range do not appear to compromise functional or morphological outcomes in DALK and DMEK.