Evaluation of grafted patients with donor corneas that today are more than 100 years old

Life expectancy is increasing. When corneal donors become older and corneal-grafted patients live longer with their graft, the need for good-quality donor tissue becomes more crucial. The aim of the present investigation is to study grafted recipients with a donor cornea with a total tissue age of more than 100 years.

One thousand consecutive donor records from the Danish Cornea Bank were initially reviewed. After applying different inclusion criteria, 35 recipients with corneal donor tissue of more than 100 years of age were invited for a follow-up visit. Visual acuity, corneal transparency and thickness, and intraocular pressure were measured. Corneal topography and endothelial photos were taken.

Seventeen of the invited patients attended the examination. The average age of the grafts at examination was 107 years old; the oldest being 118 years. Most grafts were still clear 23-35 years after transplantation, and almost one-fourth had best spectacle-corrected visual acuity (BSCVA) ≥ 0.50. Cell morphology showed irregularity in size and shape for both grafted and healthy corneas, but the alterations were more extensive in the grafted corneas. The average endothelial cell density (ECD) was 1360 mm(2) in the grafted corneas. Sixty per cent had ECD > 1000 cells/mm(2). No signs of decompensation were observed for those with <1000 cells. The average central corneal thickness of the grafts was 0.582 mm (SD = 0.067) compared with 0.494 mm (SD = 0.043) in the fellow cornea.

This study shows a trend of moderate long-term survival and quality for very old grafts despite low ECD. Most recipients had a clear transplant, and one-fifth had BSCVA of 0.80.