Outcomes of descemet stripping automated endothelial keratoplasty using imported precut versus domestic surgeon-prepared corneas

PURPOSE: To compare outcomes of imported precut corneas and domestic surgeon-prepared corneas in Descemet stripping automated endothelial keratoplasty (DSAEK) and non-DSAEK (nDSAEK). METHODS: This retrospective comparative interventional case series included forty consecutive eyes that underwent DSAEK or nDSAEK by a single surgeon between November 2017 and December 2024. Donor corneas were either imported precut from U.S. eye banks (n = 31) or prepared domestically by the surgeon (n = 9). Donor and recipient characteristics, best-corrected visual acuity (BCVA), endothelial cell density (ECD), graft survival, and complications were compared. RESULTS: Imported grafts were thinner (108.7 ± 16.7 vs. 181.1 ± 15.5 μm; P < 0.001) and had longer death-to-operation intervals (10.1 ± 1.9 vs. 6.3 ± 1.1 days; P < 0.001). Both groups achieved significant postoperative BCVA improvement. Mean initial ECD loss was greater with imported grafts but not statistically significant (26.1% vs. 19.6%; P = 0.286). At 6 months and 5 years, mean ECD loss was 23.8% and 37.3% for imported grafts and 15.4% and 52.9% for domestic grafts, respectively. Two primary failures occurred in the imported group, both in the same eye. One late failure occurred in each group-related to a retained anterior chamber intraocular lens and to messenger RNA COVID-19 vaccination, respectively. Outcomes were similar between DSAEK and nDSAEK. Postoperative BCVA was significantly better in Fuchs' endothelial corneal dystrophy (0.31 ± 0.15 LogMAR). CONCLUSION: Despite potentially greater initial ECD loss, imported precut corneas achieved comparable outcomes to domestic surgeon-prepared corneas, supporting their safety and efficacy.