Therapeutic and tectonic keratoplasty with simple cryopreserved remnants of donor corneas: an 11 year retrospective case series

Abstract

This study sought to describe the use of deep-frozen donor corneal remnants preserved after keratoplasty procedures for therapeutic or tectonic keratoplasty without subsequent optical keratoplasty. This single-center retrospective consecutive case series analyzed the electronic medical records of patients who had undergone therapeutic or tectonic keratoplasty using deep-frozen donor remains preserved in Optisol-GS, for the past 11 years at Keimyung University Dongsan Medical Center. Fifty-five surgical cases in 46 patients were included. Twenty-three surgical cases in 18 patients underwent therapeutic keratoplasty for refractory infectious corneal ulcer. Complete eradication of primary infection was achieved in 14 patients (77.8%). Tectonic keratoplasty were performed 32 cases in 28 patients. Twenty-seven of 28 patients were ultimately able to maintain anatomical integrity (96.4%). Mean uncorrected visual acuity improved from 1.77 ± 0.94 preoperatively to 1.31 ± 0.95 at the last follow-up postoperatively in the tectonic graft group by logarithm of the minimal angle of resolution (P = 0.002). There were no cases of graft rejection. Keratoplasty using cryopreserved donor tissue is a suitable surgical alternative for infectious or non-infectious corneal ulcers in elderly patients or patients with poor general condition. It could be a viable alternative to overcome the shortage of corneal donors.

Efficacy of Emergency Penetrating Keratoplasty with Cryopreserved Human Donor Corneas

“…Similar to our cryopreservation technique, Kim et al and Lim et al did not use a cryoprotectant, but stored the corneas in a culture medium (Optisol GS in both studies) at – 80 °C [ 18 , 37 ]. Kim et al examined therapeutic and tectonic keratoplasties over a total period of 11 years [ 18 ], but DALK was performed in the majority of the cases included; the average graft size of 3.7 mm was also rather small compared to the size of the transplants used in our study. Anatomical integrity could be maintained in 28 of 32 cases of tectonic keratoplasty, but these results can only be compared to ours to a limited extent, as different endpoints (enucleation vs. repeat surgery) were defined.…”

“…Cryoprotectants like glycerol and dimethyl sulfoxide (DMSO) permeate cells, thereby providing a certain degree of protection against freeze–thaw thermal injury [ 19 , 24 , 28 – 36 ]. Other conservation protocols include the use of Optisol GS (Bausch and Lomb, Irvine, CA, USA), which is applied for tectonic as well as therapeutic penetrating keratoplasties with or without subsequent optical keratoplasty [ 18 , 37 ]. When used for cryopreservation of corneas, the endothelial cell count is presumed to be low, if present at all.…”