effect of donor on clinical outcomes after penetrating keratoplasty in keratoconus

purpose: this study evaluated the effect of donor and eye bank characteristics on graft rating and clinical outcomes after penetrating keratoplasty (pk) in keratoconus-affected patients. methods: a total of 252 consecutive keratoconic eyes that underwent pk were reviewed in this retrospective interventional case series. donor data included age and sex, cause of death, death-to-preservation time, preservation-to-surgery time, epithelial and stromal status, endothelial cell density and morphology and graft rating. postoperative outcomes included visual acuity, refractive error, epithelial problems, suture-related complications, graft rejection, and graft transparency. a multivariate regression analysis assessed correlations between donor and eye bank characteristics and graft quality and postoperative outcomes. results: mean recipient and donor ages were 29.7±10.0 and 26.2±8.8 years, respectively. mean follow-up period was 66.7±38.5 months. death-to-preservation time was significantly associated with the presence of graft epithelial sloughing (p=0.005) and stromal cloudiness (p<0.001). donor age significantly influenced endothelial cell density (p=0.02), mean cell area (p=0.04), and hexagonality (p=0.01). the presence of epithelial defects on postoperative day 1 correlated significantly with death-to-preservation time (p=0.004). graft stromal edema on postoperative day 1 was significantly associated with graft epithelial sloughing (p < 0.001). postoperative visual and refractive outcomes, complications, and graft survival were not correlated with any donor or eye bank factors. conclusion: donor and eye bank variables affected the quality of donor corneas and early postoperative course. however, these effects on clinical outcomes, complications, and graft survival were insignificant.