A study of the utilization profile of donor corneas with a death-to-retrieval time of more than twelve hours

PURPOSE: The purpose of the paper is to study the utilization profile of donor corneas with death-to-retrieval time (DRT) >12 h in the Indian population and to assess the safety of endothelial keratoplasty using such corneas. METHODS: This retrospective study (Jan 2018-June 2023) analyzed eye bank records of donor corneas with DRT ≥12 h. The primary outcome assessed was the utilization rate across different keratoplasties. Secondary outcomes included records of endothelial cell density (ECD) of donor tissue. Records of outcomes of endothelial keratoplasty using such corneas in the form of postoperative recorded visual acuity, graft clarity, postoperative ECD, signs of graft infection, and failure were evaluated. RESULTS: Out of 333 donor corneas, 75.68% were suitable for transplantation, 21.3% were allocated for research, and 3% were unfit. Among transplantable corneas, 42.04% were used for optical penetrating keratoplasty (PK), 15.9% for Descemet stripping automated endothelial keratoplasty, 9.9% for therapeutic PK, 4.5% for deep anterior lamellar keratoplasty, 1.5% for patch grafts, 1.2% for tectonic PK, and 0.3% each in Descemet membrane endothelial keratoplasty and tuck in lamellar keratoplasty. Mean ECD for endothelial keratoplasty suitable corneas was 2633 ± 291 cells/mm². Minimum 6 months follow-up records of endothelial keratoplasty showed that 91% achieved best-corrected visual acuity ≥6/18 and ≥6/12 in 60%. The maximum follow-up period was 4 years. Mean ECD declined to 1857.02 ± 133.11 cells/mm² ( P < 0.0001). Graft rejection was recorded in 13.34%, elevated intraocular pressure in 18%, and graft infections in none. CONCLUSION: Properly screened corneas with DRT >12 h lead to successful endothelial keratoplasty outcomes. Traditional DRT limits should be re-evaluated, especially in regions with a shortage of donor cornea. Preservation quality, ECD, and preoperative assessment are critical.