Optimal use of donor corneal tissue: one cornea for two recipients.

Purpose: To evaluate the feasibility, safety, and efficacy of the use of 1 donor cornea for 2 recipients who required anterior lamellar and posterior lamellar keratoplasties, respectively.

Methods: Twelve eyes with anterior corneal stromal pathology and 12 eyes with irreversible endothelial dysfunction were evaluated for transplant surgery at a tertiary eye care referral center. Twelve healthy donor corneas were split into 2 parts, that is, anterior lamellar button (350-μm-thick) and posterior lamellar button (150-μm-thick) using a microkeratome (Moria, Antony, France). The anterior lamellar button was used to perform automated lamellar therapeutic keratoplasty in 12 eyes, and the posterior lamellar button was used to undertake Descemet stripping automated endothelial keratoplasty in 12 eyes. The parameters evaluated were feasibility of the procedure, intraoperative and postoperative complications, if any, and visual outcome.

Results: It was possible to use 12 donor tissues for 24 patients as envisaged. No intraoperative or postoperative complications were observed. In the automated lamellar therapeutic keratoplasty group, 83.3% (10 of 12) of patients achieved a best-corrected visual acuity (BCVA) of >20/60, and in the Descemet stripping automated endothelial keratoplasty group 75% (9 of 12) of patients achieved a BCVA of >20/60.

Conclusions: Our study demonstrates that 1 donor corneal tissue can be successfully used for 2 patients as a routine practice with appropriate and optimal case selection. Such techniques may help to reduce the magnitude of corneal blindness in developing countries where there are shortages of donor corneal tissue.