Effect of Graft rating on Results Following DALK

To evaluate the influence of donor characteristics (age, death-to-preservation time, preservation-tosurgery time, graft rating, and endothelial cell features) on clinical outcomes following deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. In this retrospective study, 290 consecutive keratoconic eyes underwent DALK using donor corneas of different qualities, ranging from fair to excellent. A multivariate regression analysis was used to assess the correlation between donor characteristics and postoperative outcomes. Mean donor and recipient ages were 33.4±13.1 and 27.7±8.0 years, respectively. Mean follow-up period was 38.2±20.2 months. The presence of epithelial defects on postoperative day 1 had a significant correlation with donor epithelial sloughing (R= 0.26, P< 0.001), preservation-to-surgery time (R= 0.21, P= 0.001), and graft rating (R= -0.17, P= 0.004). Graft stromal edema on postoperative day 1 was significantly correlated with donor epithelial sloughing (R= 0.31, P< 0.001), preservation-to-surgery time (R= 0.24, P< 0.001), and graft rating (R= -0.28, P< 0.001). Suture-related complications, graft rejection episodes, graft clarity, visual acuity, and refractive outcomes at the final follow-up examination were found to have no correlation with any donor factors. The donor features had no influence on visual and refractive outcomes and complications.