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Donor failure after corneal transplantation surgery
J N Buxton1, J A Seedor, H D Perry
1Department of Ophthalmology, New York Eye and Ear Infirmary, New York 10003.
Abstract:
Donor failure refers to graft edema present within the first 24 h after penetrating keratoplasty that persists in spite of maximal medical therapy. We reviewed the case histories of 1,351 penetrating keratoplasties. Of these, 17 (1.2%) were considered donor failures. Five cases were histopathologically consistent with Fuchs' dystrophy. Seven cases demonstrated mechanical stripping of the endothelium. Five cases, all from the same eye bank, revealed an absence of posterior stromal keratocytes. Storage medium at the eye bank of origin was found to have an alkaline pH. Careful preoperative evaluation of donor corneas is emphasized, but if an apparent "epidemic" of donor failure occurs, a thorough investigation of the eye bank methodology should be initiated.
Insights
Donor failure, characterized by early graft edema after penetrating keratoplasty, occurred in 1.2% of cases. Investigations revealed Fuchs' dystrophy, endothelial stripping, or absent keratocytes linked to eye bank storage medium pH.
Area of Science:
- Ophthalmology
- Transplantation Surgery
- Corneal Science
Background:
- Donor failure in penetrating keratoplasty presents as persistent graft edema within 24 hours.
- This condition necessitates a review of potential causes and preventative measures.
Purpose of the Study:
- To investigate the causes of early donor failure in penetrating keratoplasty.
- To identify risk factors and potential links to eye bank procedures.
Main Methods:
- Retrospective review of 1,351 penetrating keratoplasty case histories.
- Histopathological analysis of failed donor grafts.
- Evaluation of eye bank storage medium conditions.
Main Results:
- 17 cases (1.2%) exhibited donor failure.
- Identified causes included Fuchs' dystrophy (5 cases), mechanical endothelial stripping (7 cases), and absence of posterior stromal keratocytes (5 cases).
- The latter group was linked to an alkaline pH in the eye bank storage medium.
Conclusions:
- Preoperative evaluation of donor corneas is crucial.
- An "epidemic" of donor failure warrants investigation into eye bank storage methodologies, particularly pH levels.