Influence of Endothelial Cell Loss During Preservation on Graft Survival in Imported Donor Cornea

PURPOSE: To investigate the influence of preoperative endothelial cell loss on the outcome of keratoplasty for keratoconus in imported donor corneas. METHODS: Eighteen imported corneas used in keratoplasty for keratoconus patients were evaluated. Corneal endothelial cell density at the moment of preservation was obtained from the medical records and was measured immediately before the keratoplasty. Correlation of the endothelial cell loss count before and after keratoplasty was analyzed and postoperative endothelial cell loss count according to the range of preoperative endothelial cell loss was evaluated. RESULTS: Mean endothelial cell loss before and after keratoplasty was 258.94 +/- 128.58 cells/mm2 and 355.44 +/- 371.83 cells/mm2, respectively. There was a positive correlation between preoperative and postoperative endothelial cell loss count (r = 0.431, p = 0.074). The results showed statistically significant higher endothelial cell loss count after keratoplasty in the range above 250 cells/mm2 rather than below 250 cells/mm2 of preoperative endothelial cell loss count (p = 0.033). CONCLUSIONS: The preoperative decrease in endothelial cell density affected the endothelial cell loss after keratoplasty for keratoconus in imported donor corneas.

Analysis of Factors Affecting the Decrease of Endothelial Cell Density in Imported Donor Corneas

PURPOSE: To evaluate the difference between corneal endothelial cell density at the moment of preservation and at keratoplasty in imported donor corneas and to analyze the correlated factors of the difference. METHODS: Eighty-seven imported corneas were evaluated. Corneal endothelial cell density at the moment of preservation was obtained from the medical record and was measured just before the keratoplasty. Correlation of the difference in endothelial cell density with the following factors were analyzed; donor sex, donor age, death-to-preservation time, preservation-to-surgery time, death-to-surgery time, endothelial cell density at the moment of preservation, and preservation period of the corneas. RESULTS: All of the corneas showed a decrease in endothelial cell density. Mean endothelial cell density of imported donor corneas at the moment of preservation and at keratoplasty was 2789 +/- 235 cells/mm2 and 2592 +/- 254 cells/mm2 (p < 0.001), respectively. Mean endothelial cell loss was 197 +/- 148 cells/mm2, which was significantly correlated with preservation-to-surgery time, death-to-surgery time and a preservation period longer than 7 days (p = 0.042, p = 0.045, p = 0.036, respectively). CONCLUSIONS: Reduced death-to-surgery time and keratoplasty before 7 days of preservation are needed for better surgical outcome.

Microbiologic Study of Imported Donor Corneas and Preserved Solutions

PURPOSE: To evaluate the prevalence of contamination of imported donor corneas and their preserved solutions, and to characterize the spectrum of contaminating microorganisms. METHODS: Thirty-seven imported donor corneas and their preserved solutions imported between December 2003 and June 2005 were included in this study. RESULTS: Five imported donor corneas (13.5%) had positive bacterial cultures, and none had positive fungal or mycobacterial cultures. On the other hand, the preserved solutions did not have positive bacterial, fungal, or mycobacterial cultures. One of the 5 imported donor corneas with positive bacterial culture had a mixed bacterial culture. There were 3 isolates of Staphylococcus epidermidis, 1 isolate of Streptococcus viridans, 1 isolate of Enterobacter cloacae, and 1 isolate of Pseudomonas aeruginosa. CONCLUSIONS: The prevalence of contamination of imported donor corneas is low; however, there is a risk of postkeratoplasty infection by contaminated donor corneas. Thus, careful management should be practiced during and after corneal transplant operations.