Efficacy of Emergency Penetrating Keratoplasty with Cryopreserved Human Donor Corneas

Abstract

Introduction: To investigate the long-term outcomes of emergency penetrating keratoplasty using cryopreserved human donor corneas in the management of actual or imminent corneal perforation.

Methods: A retrospective analysis was performed of the treatment efficacy of emergency penetrating keratoplasty using a cryopreserved human donor cornea, in 14 eyes of 14 patients with corneal ulcers of different etiology. For comparison, the medical histories of 14 patients who had undergone penetrating keratoplasty with the same indication, but received a regularly processed human corneal graft, were retrospectively analyzed. In both groups, the primary endpoint for graft failure was repeat surgery, defined as the necessity for amniotic membrane transplantation, conjunctival flap, or repeat penetrating keratoplasty, during a follow-up time of maximally 12 months.

Results: The difference in the need for repeated surgeries between the cryopreserved human donor cornea group and cultivated tissue graft group was not statistically significant (p = 0.835). Specifically, repeat complex surgery of any kind within 6 months was necessary in 50% of the cryopreserved cornea group and in 57.1% of the control group, with no further surgical interventions during the remainder of the follow-up period. However, repeat penetrating keratoplasty occurred more frequently in the cryopreserved cornea group (n = 5) than in the control group (n = 1) during the first 12 months after treatment (p = 0.048).

Conclusion: Cryopreserved corneas appear to be a viable option for promptly addressing emergencies and stabilizing the corneal situation, providing a faster solution compared to waiting for fresh tissue availability. However, repeat penetrating keratoplasty is more frequent when cryopreserved human donor corneas are used. Cryopreserved human donor corneas may be useful if surgical treatment is urgent and alternative options, such as tissue use, a conjunctival flap, or multilayer amniotic membrane transplantation, are not available.

Keywords: Corneal perforation; Corneal tissue preparation; Corneal ulcer; Cryopreserved corneal graft; Penetrating keratoplasty.

Fig. 1

Upper images: left eye of patient 8 (group A) at baseline (a), day 1 (b) and day 287 (c) following keratoplasty. Lower images: right eye of patient 26 (group B) at baseline (d), day 1 (e), and day 203 (f) following keratoplasty

Fig. 2

Boxplot of the best corrected visual acuity (in LogMAR) before and 6 months after keratoplasty in group A and group B. Finger counting (CF) was defined as 2.1, hand movement (HM) as 2.4, light perception (LP) as 2.7, and no light perception (NLP) as 3.0

Fig. 3

Kaplan–Meier analysis of days of transplant survival, defined as days without repeat surgery, for groups A and B (log-rank test, p = 0.835)

Fig. 4

Kaplan–Meier analysis of days of transplant survival, defined as days without repeat keratoplasty, for groups A and B (log-rank test, p = 0.048)