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Pseudophakic corneal donor tissue in Descemet membrane endothelial keratoplasty (DMEK): implications for cornea banks and surgeons
  1. Daniel Pilger1,
  2. Necip Torun2,
  3. Anna-Karina B Maier1,
  4. Jan Schroeter3
  1. 1Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
  2. 2Augentagesklinik Chausseestraße, Berlin, Germany
  3. 3University Tissue Bank, Institute for Transfusion Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Daniel Pilger; daniel.pilger{at}


Objective Increasingly, cornea banks are recovering donor tissue from pseudophakic donors. Little is known about their suitability for Descemet membrane endothelial keratoplasty (DMEK) surgery in terms of endothelial cell density (ECD) and preparation failure.

Methods and Analysis We explored ECD during donor tissue preparation in 2076 grafts. Preparation failure was analysed in 1028 grafts used in DMEK surgery at our clinic. To monitor ECD and functional results, we matched 86 DMEK patients who received pseudophakic donor grafts with similar recipients of phakic donor grafts and followed them up for 36 months.

Results At recovery, mean ECD in pseudophakic donor grafts was 2193 cells/mm2 (SD 28.7) and 2364 cells/mm2 (SD 15.7) in phakic donor grafts (p<0.001). After cultivation, the difference increased as pseudophakic donor grafts lost 14% of ECD while phakic lost only 6% (p<0.001). At transplantation, mean ECD in pseudophakic donor grafts was 2272 cells/mm2 (SD 250) and 2370 cells/mm2 (SD 204) in phakic donor grafts (p<0.001). After transplantation, the difference in ECD increased as pseudophakic donor grafts lost 27.7% of ECD while phakic donor grafts lost only 13.3% (p<0.001). The risk of preparation failure in pseudophakic donor grafts was higher than in phakic donor grafts (OR 4.75, 95% CI 1.78 to 12.67, p=0.02). Visual acuity increased in both groups similarly.

Conclusions Pseudophakic donor grafts have a lower ECD, are more prone to endothelial cell loss during recovery and surgery and are associated with a higher risk of preparation failure. Cornea banks and surgeons should consider this in the planning of graft preparation and transplantation.

  • cornea
  • dystrophy
  • treatment surgery

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  • Contributors DP conducted the study, performed the analysis and wrote the first draft of the manuscript. AKBM and JS contributed to the analysis and interpretation of the findings and added to the writing of the manuscript. DP and JS conceived the study. NT performed the surgeries, interpreted the findings and contributed to the writing of the final manuscript. DP, JS and NT act as guarantors for the overall content of this work.

  • Funding DP is a participant in the BIH Charité Clinician Scientist Program funded by the Charité-Universitätsmedizin Berlin and the Berlin Institute of Health.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study obtained ethical clearance by the Charité Ethical Committee (EA4/167/16).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

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