Validation of Tissue Quality Parameters for Donor Corneas Designated for Emergency Use in Preservation of the Globe

Abstract

To validate tissue quality parameters for donor corneas designated for emergency grafting to preserve the globe. In a longitudinal cohort follow-up study, 151 emergency grafts in the Netherlands were studied. Grafts were performed with a pool of organ-cultured donor corneas designated for emergency grafting and prepared for immediate use with all safety tests performed. Assignation criteria were corneas with a small superficial stromal opacity but meeting all selection criteria for penetrating keratoplasty tissue and corneas without stromal opacity but an endothelial cell density from 1800 to 2300 cells per square millimeter or mild polymegethism or pleomorphism. Cox multivariate regression analysis, Kaplan-Meier survival, and log rank test were applied. All requests for corneal tissue were honored within 24 hours. Ninety-one patients showed a complete and 60 an imminent perforation. One hundred thirty-one penetrating grafts and 20 lamellar grafts have been used. The globes were saved in 140 of the 151 patients (92.7%). Globe preservation was not significantly related to the absence of penetrating keratoplasty quality of the donor endothelium, the type of grafting, the degree of vascularization in the host cornea, or diabetic disease in the recipient. The main risk factor for globe preservation was the presence of a systemic autoimmune disease in the recipient (P = 0.0021). A selected pool of donor corneas designated for emergency grafting, that does not interfere with the scheduled procedures, allows more efficient and safe use of donor tissue in case of an imminent perforation. Globe preservation rates justify the quality criteria for designation of this tissue.