OUTCOME OF DONOR GRAFT QUALITY ON CLINICAL RESULTS AFTER PENETRATING KERATOPLASTY FOR KERATOCONUS

Aim: To evaluate the effect of donor and eye bank characteristics on graft rating and medical results after penetrating keratoplasty (PK) in the keratoconus.

Place and Duration: In the Eye Unit-1 of Lahore General Hospital, Lahore for 3 years duration from March 2017 to February 2020.

Methods: 252 keratoconic PK eyes were used in this retrospective interventional case series. Donor data include age and gender, cause of death, stromal and epithelial status, death‑to‑preservation time, time of surgery, morphology, transplant classification and endothelial cell density (ECD). Post-operative results involved visual refractive error, acuity, suture complications, epithelial problems, transplant transparency and transplant rejection. In the multivariate regression analysis, the correlation among donor and eye bank characteristics, post-operative results and graft quality was assessed.

Results: The average age of donor and recipient was 26.2 ± 8.8 and 29.7 ± 10.0 years, and the 66.7 ± 38.5 months was the mean follow-up time, correspondingly. Death‑to‑preservation time was signifcantly related with the incidence of
stromal cloudiness (P < 0.001) and graft epithelial sloughing (P = 0.005). The donor's age suggestively prejudiced endothelial cell density (P = 0.02), hexagonicity (P = 0.01) and mean cell area (P = 0.04). The occurrence of defects of epithelium = on the 1^st day after surgery was suggestively correlated with the death‑to‑preservation time (p = 0.004). On the first post-operative day, graft stromal edema was found to be suggestively related with graft epithelial sloughing (P <0.001). Post-operative refractive and visual results, survival and transplant complications were not associated with any ocular or donor factor.

Conclusion: Eye bank and donor variables influenced donor corneal quality and early post-operative course. Though, the longstanding consequence on transplant complications, survival and clinical outcome were negligible.

Keywords: donor quality; keratoconus; Penetrating keratoplasty; Postoperative results.