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Aims-Donor organ cultured corneal tissue selection before penetrating keratoplasty is carried out by taking into account diVerent variables. The objective was to identify preoperative variables which are significantly and independently associated with transplant outcome and should eVectively be taken into account before transplantation. Methods-231 consecutive penetrating keratoplasties were prospectively studied using organ cultured tissue. Morphometric analysis of the donor corneal endothelium was performed before transplantation. Graft survival and endothelial cell density, during the second year following transplantation, were studied both at a univariate and multivariate level. Results-Recipient age, recipient rejection status, and preoperative diagnosis significantly influenced graft survival. Graft survival was higher when using corneal tissue from donors older than 80 years. Postoperative endothelial density decreased with preservation time and coeYcient of variation after preservation. It increased with endothelial cell density after preservation and deswelling time, and correlated with preoperative diagnosis. Conclusion-Organ cultured corneas with endothelial cell density after preservation <2000 cells/mm 2 , and high coeYcient of variation, may be discarded before transplantation. Corneas should be preserved for less than 3 weeks, and allowed to deswell before transplantation for 2 or 3 days rather than 1 day. (Br J Ophthalmol 1998;82:382-388)

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