Endothelial keratoplasty outcomes of domestic versus imported donor corneas

To compare keratoplasty outcomes of domestic versus imported donor corneas.

A retrospective comparative case series including 193 consecutive endothelial keratoplasty procedures, with 94 procedures (49%) performed using imported corneas (Imported group) and 99 procedures (51%) performed using domestic corneas (Domestic group). The main outcome was graft survival. The secondary outcome was postoperative best-corrected visual acuity (BCVA).

Baseline recipient characteristics did not differ significantly between the groups. The mean follow-up time was 12.0 ± 8.2 months. The Domestic group showed an increased preoperative endothelial cell density (2937 ± 333 vs 2810 ± 272 cells/mm 2 ), a shorter death-to-preservation time (6.9 ± 5.0 vs 12.5 ± 5.5 hours), and a shorter death-to-transplant time (6.6 ± 2.1 vs 8.9 ± 1.5 hours). The survival probability of domestic corneas at 6, 12, and 24 months was 94%, 91%, and 86%, respectively. The survival probability of imported corneas was 88%, 88%, and 88%, respectively. Survival distribution did not differ significantly between the groups ( P = 0.539). The mean postoperative BCVA was 0.55 ± 0.54 logMAR in the Domestic group ( n = 59) and 0.58 ± 0.60 logMAR in the Imported group ( n =58, P = 0.623).

Graft survival rates and visual outcomes did not differ between imported and domestic corneas, despite significant baseline differences, which include preoperative endothelial cell count, death-to-preservation time, and death-to-transplant time. A trend toward higher primary failure rates with imported corneas warrants further investigation.