Split cornea transplantation for 2 recipients: a new strategy to reduce corneal tissue cost and shortage

Ophthalmology. 2011 Feb;118(2):294-301. doi: 10.1016/j.ophtha.2010.05.025. Epub 2010 Aug 17.


Purpose: To evaluate the feasibility of using a single donor cornea for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) surgeries on the same day.

Design: Single-center, nonrandomized, prospective, interventional case series.

Participants: Twelve consecutive donor corneas were scheduled for split cornea transplantation combining DALK for a keratoconus patient and DMEK for a Fuchs' endothelial dystrophy patient on the same surgery day.

Methods: First, a big-bubble DALK procedure was performed for the keratoconus eye. When bare Descemet's membrane was prepared successfully requiring no conversion to penetrating keratoplasty (PK), then during surgery the donor, endothelium-Descemet's membrane layer was removed and stored for subsequent DMEK in a second patient, and the remaining anterior lamella of the donor cornea was used to complete the DALK surgery. Afterward, a DMEK procedure was performed on the second patient with Fuchs' endothelial dystrophy, grafting the stored endothelium-Descemet's membrane layer of the original donor button.

Main outcome measures: Success of using a single donor cornea for 2 recipient eyes, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months follow-up.

Results: A single donor cornea could be used for 2 recipients in 10 of 12 donor buttons (83%). In 2 cases (17%), the DALK procedure had to be converted to PK requiring a full-thickness corneal graft. Therefore, 10 donor corneas (45%) could be saved. Six months after surgery, mean BSCVA was 20/35 (range, 20/50-20/25) in 10 eyes that underwent successful DALK, 20/50 (range, 20/63-20/40) in 2 eyes that underwent conversion from DALK to PK, and 20/31 (range, 20/50-20/16) in 10 eyes that underwent DMEK. Postoperative complications after DALK included Descemet's folds in 3 eyes (30%) and epitheliopathy in 2 eyes (20%). After DMEK, partial graft detachment occurred in 5 eyes (50%) and was managed successfully with intracameral air reinjection. All corneas remained clear up to 6 months after surgery.

Conclusions: Split use of donor corneal tissue for combined DALK and DMEK procedures in 2 recipients on the same surgery day is a promising strategy to reduce donor shortage and cost in corneal transplantation surgery in the future.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Count
  • Cornea*
  • Corneal Transplantation / economics*
  • Corneal Transplantation / methods
  • Descemet Stripping Endothelial Keratoplasty / economics*
  • Descemet Stripping Endothelial Keratoplasty / methods
  • Endothelium, Corneal / pathology
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Fuchs' Endothelial Dystrophy / physiopathology
  • Fuchs' Endothelial Dystrophy / surgery*
  • Humans
  • Keratoconus / physiopathology
  • Keratoconus / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prognosis
  • Prospective Studies
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Procurement / economics*
  • Tissue and Organ Procurement / methods
  • Visual Acuity / physiology
  • Young Adult