Corneal Donor Tissue Quality Has Increased

Between 2007 and 2024, there was a shift toward pre-cut corneal tissue in the United States, which resulted in reduced total operative time and potential improvements in the quality and viability of the transplanted tissue. Standardization of tissue procurement, processing and storage, as well as the adoption of endothelial keratoplasty, likely also contributed to lower rates of graft failure. Photo: Kathleen Kelley, OD, Francis Price, Jr., MD, and Marianne Price, PhD. Click image to enlarge. Tissue used in corneal transplantation procedures is carefully processed by eye banks according to strict criteria for donor evaluation, tissue recovery and tissue preparation. These measures aim at reducing risk and adverse outcomes. Though tissue processing and surgical innovations of the last decade have improved safety and quality, experts point out that the current trends of adverse events and tissue characteristics haven’t been well characterized.To investigate, researchers at the University of Michigan obtained eye bank data spanning a 17-year period and conducted a longitudinal analysis across adverse event type and procedure type. Their findings, published recently in American Journal of Ophthalmology, reveal that tissue-related adverse events in the early postoperative period have been on the decline.In total, the study included 126,072 donor corneal tissues. The researchers reported 176 tissue-related adverse events, reflecting an estimated prevalence of 0.14%. Their analysis showed that for every year, there was a 6.7% reduction in the likelihood of a tissue-related adverse event occurring, representing an estimated reduction by almost 70% over 17 years.By procedure, DSAEK had a 2.3 odds ratio (OR) and DMEK had a 2.8 OR of an adverse event compared to penetrating keratoplasty. There was no significant difference in the rate of improvement for penetrating keratoplasty to DSAEK or penetrating keratoplasty to DMEK.The researchers noted that rates of infectious keratitis (OR, 0.91) and primary graft failure (OR, 0.9) demonstrated significant improvements year over year. On the other hand, endophthalmitis and early regraft rates didn’t significantly improve.Based on these findings, they concluded that there’s continual improvement in corneal transplant safety. “These findings may help alleviate patient uncertainty when undergoing specific corneal procedures and may also benefit emerging techniques for perioperative counseling,” the researchers wrote in their paper.  Click here for the journal source. Reddy K, Dmitriev PM, Hurlbert S, et al. Longitudinal trends in tissue-related adverse events after corneal transplantation. Am J Ophthalmol 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.