The results of successful penetrating keratoplasty using donor organ-cultured corneal tissue

Background. The aim of this study was identification of predictive factors for postoperative visual acuity in patients with a clear organ-cultured gra ft and to analyze the change in visual acuity between 12 and 24 months afte r transplantation. Methods. The study design was a prospective cohort study. A total of 342 co nsecutive penetrating keratoplasties using donor organ-cultured grafts, per formed in 324 patients, were included. Visual acuity, graft thickness, and graft endothelial cell density were recorded in patients with clear transpl ants. Results. At 24 months postoperatively, 25 (18.7%) of 134 patients had 20/20 0 or worse visual acuity and 66 (49.3%) had 20/40 or better visual acuity, Graft thickness book 1 month to decrease to normal values. A temporary graf t thinning occurred at 6 months postoperatively, followed by recovery of no rmal graft thickness by 18 months. The average postoperative endothelial ce ll density was 1,533+/-598 cells/mm(2) during the second year. The 24-month LogMAR (logarithm of minimal angle of resolution) visual acuity correlated with preoperative LogMAR visual acuity (beta=0.26, P=0.005), postoperative lens status (beta=-0.34, P=0.009), preoperative intraocular pressure (beta =0.50, P=0.020), and postoperative astigmatism (beta=0.17, P=0.040), Visual acuity (P=0.022) significantly improved between 1:1 and 24 months. Preoper ative diagnosis (P < 0.0001) and postoperative lens status (P < 0.0001) sig nificant:ly influenced the change in LogMAR visual acuity between 12 and 24 months. Conclusions. Donor variables do not influence the visual acuity results of penetrating keratoplasty using organ-cultured donor tissue, whereas they ha ve a strong influence on graft survival and graft endothelial cell density. Visual acuity improves during the first 2 years after transplantation. Aft er keratoplasty, organ-cultured corneal grafts undergo dramatic modificatio ns of their thickness and probably of their transparency.