Analysis of clinical factors affecting corneal endothelial cell density in eye bank donors

To systematically analyze factors influencing corneal endothelial cell density (ECD) in eye bank donors and provide robust evidence for optimizing donor screening strategies.

A retrospective analysis was conducted on 1438 corneas from 782 donors (2013-2025). Associations between ECD and donor age, sex, laterality, cause and season of death, cataract surgery, cancer, Diabetes Mellitus (DM), and death-to-preservation time (DTP) were evaluated using univariate analysis and a generalized linear mixed model (GLMM).

Univariate analysis showed ECD was significantly associated with age, cataract surgery, DTP, cause of death, and death season (all P < 0.05). The GLMM indicated that age, cataract surgery, and DTP were highly significant independent predictors (all P < 0.001): ECD was 287.737 cells/mm² higher in donors without cataract surgery (95% CI: 177.109-398.365), and decreased by 3.847 cells/mm² (95% CI: -5.561 to -2.134) per year of age and 18.342 cells/mm² (95% CI: -27.623 to -9.062) per hour increase in preservation time. Among causes of death, only the cardiovascular/cerebrovascular disease group differed significantly from the chronic organ failure group (P = 0.013); other factors including sex, eye laterality, cancer, DM, and death season showed no independent effects (all P>0.05).

Advanced age, prior cataract surgery, and prolonged death-to-preservation time were independently associated with lower ECD. Cause of death was not an independent predictor overall, although donors who died from CCVDs had significantly higher ECD than those with chronic organ failure. These findings provide a robust evidence base for clinical donor screening and allocation, thereby maximizing the utility of scarce donor corneas.