Purpose To evaluate the efficiency of using anterior segment optical coherence tomography (AS-OCT) as a non-invasive and sterile screening method in the eye bank to detect corneal grafts with curvature and/or thickness anomalies, thus improving the graft selection for corneal transplantation.

Methods 1222 donor corneal tissues mounted in sterile organ culture flasks were imaged using an AS-OCT (CASIA 2 – Tomey, Nagoya, Japan) between January 2018 and September 2022. The corneal tissues were preserved at least 12 hours in organ culture medium 2 (containing 6% dextran T-500) before the measurement in order to allow deswelling prior to the examination. Depth scans were performed sterilely through the organ culture flask from the posterior surface of the corneal tissues within a 7 mm central zone to create 3D volume data. The volume data set was imported to MATLAB (MathWorks Inc., Natick, Massachusetts, USA) and, after preprocessing the data and defining the region of interest (ROI), the edge of the front and back surfaces of the corneal tissues was detected. Subsequently, the adaptation of a sphero-cylindrical surface model was carried out with raytracing. The radii of curvature for the front and back surfaces and the central corneal thickness were determined according to the method proposed by Mäurer, Eppig, Langenbucher et al at the Institute of Experimental Ophthalmology, Homburg/Saar, Germany.

Results The mean steep/flat front surface radius was 7.46 ± 0.29 (6.07 – 9.29)/7.69 ± 0.24 (6.70 – 9.50) mm, the corresponding values for the back surface being 6.48 ± 0.32 (5.30 – 8.00)/6.80 ± 0.31 (5.81 – 8.00) mm and the mean central thickness was 611.5 ± 85.6 (378.5 – 1457.2) μm. Anomalies (beyond ± 2 or ± 3 standard deviations SD) were found in 111 or 41 corneas (9.1% or 3.4%) for anterior surface curvature, 135 or 38 for corneas (11.0% or 3.1%) for the posterior surface, and 53 or 15 corneas (4.3% or 1.2%) for central corneal thickness.

Conclusion The AS-OCT provides an objective, sterile and semi-automated screening method to identify corneal morphological and refractive alterations (e.g. keratoconus, status post keratorefractive surgery) to further optimize corneal donor selection in the eye bank. Corneal donors with curvature or thickness anomalies +/- 3 SD (eminence-based) do not have to be discarded but can be used for posterior lamellar keratoplasty, especially DMEK in Germany.