Donor Graft Quality Used for Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Abstract

Deep anterior lamellar keratoplasty (DALK) has been recently introduced as an alternative to penetrating keratoplasty (PK) for corneal pathologies not involving corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, it provides a greater availability of donor corneas that do not need perfectly healthy endothelium and high endothelial cell density to be suitable for PK. Furthermore, as lamellar corneal surgery expands the potential use of acellular corneal tissue, long-term preservation techniques are being revisited as a way to increase availability of corneal tissue to alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in the technique of corneal transplantation and hence the type of donor cornea tissues used for each technique, may require eye banks and corneal surgeons to reassess their selection criteria but it is important for any changes to be evidence-based. The purpose of this chapter, therefore, is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, to evaluate the impact of donor and eye bank variables on the suitability of corneas for transplantation and then go on to determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.