Influence of Graft Donor Age in Descemet Membrane Endothelial Keratoplasty

To investigate differences between 3 donor age groups in their influence on complication rates during preparation or implantation and on the postoperative outcome of Descemet membrane endothelial keratoplasty (DMEK).

Retrospective comparison of 2067 eyes (1374 patients) undergoing DMEK, divided into 3 subgroups [1: <50 years (n = 63); 2: 50 to 80 years (n = 1607), 3: >80 years (n = 397)]. The data of visual acuity, central corneal thickness, and endothelial cell count, intra- and postoperative complications were collected.

Although transplants from group 1 were significantly more likely to have severe double roll forming than the older donors ( P <0.001), this fact had no significant influence on intraoperative complications ( P = 0.26), postoperative endothelial cell count ( P = 0.28), or the rebubbling rate ( P = 0.35). The rebubbling rate and transplant flip rate were found to be highest in group 3, although these findings did not attain statistical significance. Furthermore, this did not result in a higher repeat keratoplasty rate, as this was comparable in the 3 groups. Although visual acuity and central corneal thickness were comparable across the 3 groups, endothelial cell count differed significantly over time. At the initial follow-up, endothelial cell loss was 33% to 35% in all groups. However, subsequent clinical courses revealed a substantial variation, with group 3 displaying the highest endothelial cell loss after 2 years ( P = 0.026).

The use of younger donor corneas <50 years and older donor corneas >80 years seems to be suitable for DMEK surgery after liquid-bubble preparation under organ culture conditions and should not be categorically excluded to counteract the global donor shortage.