Single donor cornea may be used for two transplantation procedures

Cornea. 2011;30(10):1140-1144

Issue: November 10, 2011

One donor cornea may be divided into anterior and posterior lamellar discs for corneal transplantation in two patients, a study found.

"Such techniques may help to reduce the magnitude of corneal blindness in developing countries where there are shortages of donor corneal tissue," the study authors said. "In developing countries such as India, there is an annual demand of 300,000 corneas but only 15,000 corneas are available, creating a discrepancy in the demand and supply of the donor tissue."

The retrospective study included 12 eyes with anterior corneal stromal pathology and 12 eyes with irreversible endothelial dysfunction.

A microkeratome was used to split each of 12 healthy donor corneas into two parts: 350-µm anterior lamellar buttons and 150-µm posterior lamellar buttons. Anterior lamellar buttons were used to perform automated lamellar therapeutic keratoplasty (ALTK) in 12 eyes. Posterior lamellar buttons were used for Descemet's stripping automated endothelial keratoplasty in 12 eyes.

Mean patient age was 48.5 years in the ALTK group and 56.7 years in the DSAEK group. Mean follow-up was 20 months to 44 months in the ALTK group and 20.5 months to 45 months in the DSAEK group.

Study results showed that 10 patients in the ALTK group (83.3%) and nine patients in the DSAEK group (75%) attained best corrected visual acuity of at least 20/60. Vision improved significantly (P < .001) in both groups. No intraoperative or postoperative complications were reported, the authors said.

Sharma et al have demonstrated that a single donor cornea can be dissected with a microkeratome and the separate pieces can be used successfully for two transplant procedures, with one recipient undergoing anterior lamellar keratoplasty (ALTK) and the other Descemet stripping automated endothelial keratoplasty (DSAEK). Another method of splitting the cornea is to strip off Descemet’s membrane and attached endothelium and use the separate pieces for deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). Heindl et al recently showed this method provides superior visual outcomes for both recipients. (Split cornea transplantation for 2 recipients – review of the first 100 consecutive patients. Am J Ophthalmol 2011;152(4):523-532). Splitting a donor cornea is a useful way to allow more patients to benefit from keratoplasty, because the supply of donor corneas is frequently a limiting factor, particularly in developing nations.

– Marianne O. Price, PhD
Executive Director, Cornea Research Foundation of America, Indianapolis
Disclosure: Dr. Price has no relevant financial disclosures.