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Prospective, Randomized Clinical and Endothelial Evaluation of 2 Storage Times for Corneal Donor Tissue in Organ Culture at 31°C
Gilles Thuret, MD;
Christophe Chiquet, MD;
Fabienne Bernal, MD;
Sophie Acquart, PhD;
Jean-Paul Romanet, MD;
Michel Mouillon, MD;
Harald Hegelhoffer, PhD;
Carole Burillon, MD;
Odile Damour, PhD;
Jean Maugery, MD;
W. John Armitage, PhD;
Philippe Gain, MD, PhD
Arch Ophthalmol. 2003;121:442-450.
Objective To compare the endothelial and clinical outcome of penetrating keratoplasty with corneas stored in organ culture for up to 12 days (5-12 days; group 1) or more than 21 days (21-24 days; group 2).
Methods We conducted a controlled double-masked trial. Storage durations were randomly assigned to the paired corneas, and endothelial cell density (ECD) was measured at the start and end of organ culture. Patients with a low rejection risk and preoperative ECD within the reference range were randomly assigned to 1 of the 2 groups and underwent an 8.25-mm penetrating keratoplasty (n = 25 pairs). Follow-up at day 5 and months 1, 6, and 12 included central ECD, morphometry, graft transparency, visual acuity, pachymetry, and complications. The main outcome measure was the central ECD at month 12.
Results At the end of organ culture, ECD of the group 1 corneas was higher by 273 cells/mm2 (95% confidence interval [CI], 178-368; P<.001). One year after penetrating keratoplasty, the group 1 ECD was still comparably higher by 227 cells/mm2 (95% CI, 43-411; P = .02). Graft transparency, pachymetry, and complication rate did not differ at any time. In group 1, visual acuity was better at month 1.
Conclusions Shorter organ culture allows delivery of corneas with higher ECD. Recipients with ECD within the reference range and low rejection risk retain this initial benefit 1 year postoperatively. The higher endothelial cell capital may prevent or delay late endothelial failure, the leading cause of graft failure in these recipients. We therefore prefer short-term storage for such recipients.
From the Departments of Ophthalmology, University Hospital, and the Cornea Banks, Establissement Français du Sang of Saint-Etienne, Saint-Etienne, France (Drs Thuret, Chiquet, Acquart, Burillon, Damour, Maugery, and Gain), and Grenoble, France (Drs Bernal, Romanet, Mouillon, and Hegelhoffer); and the Division of Ophthalmology, Bristol Eye Hospital, Bristol, England (Dr Armitage). The authors have no relevant financial interest in this article.
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