Split cornea transplantation for 2 recipients: a new strategy to reduce corneal tissue cost and shortage.
OBJECTIVE
To evaluate the feasibility of using a single donor cornea for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) surgeries on the same day.


METHODS
Single-center, nonrandomized, prospective, interventional case series.


METHODS
Twelve consecutive donor corneas were scheduled for split cornea transplantation combining DALK for a keratoconus patient and DMEK for a Fuchs' endothelial dystrophy patient on the same surgery day.


METHODS
First, a big-bubble DALK procedure was performed for the keratoconus eye. When bare Descemet's membrane was prepared successfully requiring no conversion to penetrating keratoplasty (PK), then during surgery the donor, endothelium-Descemet's membrane layer was removed and stored for subsequent DMEK in a second patient, and the remaining anterior lamella of the donor cornea was used to complete the DALK surgery. Afterward, a DMEK procedure was performed on the second patient with Fuchs' endothelial dystrophy, grafting the stored endothelium-Descemet's membrane layer of the original donor button.


METHODS
Success of using a single donor cornea for 2 recipient eyes, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months follow-up.


RESULTS
A single donor cornea could be used for 2 recipients in 10 of 12 donor buttons (83%). In 2 cases (17%), the DALK procedure had to be converted to PK requiring a full-thickness corneal graft. Therefore, 10 donor corneas (45%) could be saved. Six months after surgery, mean BSCVA was 20/35 (range, 20/50-20/25) in 10 eyes that underwent successful DALK, 20/50 (range, 20/63-20/40) in 2 eyes that underwent conversion from DALK to PK, and 20/31 (range, 20/50-20/16) in 10 eyes that underwent DMEK. Postoperative complications after DALK included Descemet's folds in 3 eyes (30%) and epitheliopathy in 2 eyes (20%). After DMEK, partial graft detachment occurred in 5 eyes (50%) and was managed successfully with intracameral air reinjection. All corneas remained clear up to 6 months after surgery.


CONCLUSIONS
Split use of donor corneal tissue for combined DALK and DMEK procedures in 2 recipients on the same surgery day is a promising strategy to reduce donor shortage and cost in corneal transplantation surgery in the future.
Heindl
Ludwig M
LM
Department of Ophthalmology and Eye Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. ludwig.heindl@uk-erlangen.de
Riss
Stephan
S
Bachmann
Bjoern O
BO
Laaser
Kathrin
K
Kruse
Friedrich E
FE
Cursiefen
Claus
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003315:Cornea; D016039:Corneal Transplantation / Q000191:economics* / Q000379:methods; D057111:Descemet Stripping Endothelial Keratoplasty / Q000191:economics* / Q000379:methods; D004728:Endothelium, Corneal / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000379:methods; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult