Donor Tissue Culture Conditions and Outcome after Descemet Membrane Endothelial Keratoplasty

PURPOSE: To investigate the effect of culture conditions of donor tissue on functional outcome after Descemet membrane endothelial keratoplasty. DESIGN: Retrospective, single-center, consecutive case series. METHODS: Descemet membrane endothelial keratoplasty was performed routinely in 82 eyes of 82 consecutive patients using corneal donor tissue prestored in either short-term culture (Optisol-GS; Bausch & Lomb) at 4 C (group A; n = 37) or organ culture (Dulbecco Modified Eagle Medium [Biochrom]; CorneaMax Medium [Eurobiol) at 34 C (group B; n = 45) in a randomized fashion. Main outcome measures included the number of air injections necessary for graft attachment as well as best-corrected visual acuity (in logarithm of the minimal angle of resolution [logMAR] units), central corneal thickness, and endothelial cell density at 1, 3, and 6 months after surgery. RESULTS: Best-corrected visual acuity increased from 0.69 +/- 0.53 logMAR and 0.67 +/- 0.31 logMAR before surgery to 0.33 +/- 0.21 logMAR and 0.28 +/- 0.18 logMAR after 1 month (P < .05), to 0.24 +/- 0.16 logMAR and 0.18 +/- 0.16 logMAR after 3 months (P < .05), and to 0.18 +/- 0.12 logMAR and 0.15 +/- 0.10 logMAR after 6 months (n.s.) in groups A and B, respectively. Endothelial cell density decreased from 2647 +/- 236 cells/mm(2) and 2515 +/- 249 cells/mm(2) before surgery to 1499 +/- 277 cells/mm(2) and 1526 +/- 205 cells/mm(2) after 1 month (P < .05), to 1441 +/- 213 cells/mm(2) and 1443 +/- 316 cells/mm(2) after 3 months (n.s.), and to 1587 +/- 366 cells/mm(2) and 1457 +/- 285 cells/mm(2) after 6 months (n.s.) in groups A and B, respectively. Central corneal thickness declined from 664 +/- 89 and 662 +/- 107 mu m before surgery to 529 +/- 92 mu m and 517 +/- 62 pm after 1 month (P < .05), to 511 +/- 46 mu m and 510 +/- 46 pm after 3 months (P < .05), and to 529 +/- 68 mu m and 507 +/- 50 mu m after 6 months (n.s.) in groups A and B, respectively. Best-corrected visual acuity, endothelial cell density, and central corneal thickness values showed no significant differences between both groups at any time point after surgery. However, a significantly higher total number of air injections was necessary in group A (n = 34) compared with group B (n = 26) to obtain graft attachment (P < .05). CONCLUSIONS: These findings suggest that donor tissue culture conditions have no significant effect on functional outcome, but may influence graft adhesion and rebubbling rate after Descemet membrane endothelial keratoplasty surgery. (Am J Ophthalmol 2011;151:1007-1018. (C) 2011 by Elsevier Inc. All rights reserved.)