Increased Endothelial Cell Loss After Transplantation of Corneas Preserved by a Modified Organ-culture Technique

Forty-seven donor corneas were preserved in McCarey-Kaufman (M-K) medium at 4°C for 1 day, then in organ culture at 34°C for approximately 1 month, then in M-K medium at 4°C for an additional two days before transplantation. The central donor endothelium was examined by specular microscopy before and after organ culture and 2 months after keratoplasty. No significant change in central endothelial cell density occurred during organ culture. The 47 transplants were compared with 47 grafts preserved only in M-K medium at 4°C for approximately 36 hours. All transplants were performed by the same surgeon over the same period, and the two groups contained similar types of surgical procedures. The organ-cultured grafts were thicker on the first postoperative day and took longer to epithelialize. Two months after keratoplasty all of the 94 grafts were clear and thin, but the mean central endothelial cell loss was 28% in the 47 organ-cultured transplants and 10% in the 47 transplants preserved only in M-K medium (P < 0.0001). These results indicate that the endothelium of corneas preserved by organ culture at 34°C and then placed in M-K medium at 4°C for 2 days may be more susceptible to surgical trauma than those preserved only in M-K medium at 4°C.