Younger Donor Tissue in Descemet Membrane Endothelial Keratoplasty Surgery: Clinical Outcomes

Purpose: To determine whether using younger donor tissue for Descemet membrane endothelial keratoplasty (DMEK) surgery influences clinical outcomes. Methods: Scroll tightness, unscrolling time, rebubble rate, and preoperative and 3- and 6-month postoperative endothelial cell density (ECD) and endothelial cell loss (ECL) were compared for 661 DMEK grafts prepared from younger (aged younger than 50 yrs, n = 81) and older donors (aged 50 yrs or older, n = 580) with Student t test, chi(2) test, or Mann-Whitney U test. Results: There was no difference in overall unscrolling time (younger donors: 3.1 +/- 3.1 min, older donor: 2.9 +/- 2.7 min, P = 0.503). Experienced faculty surgeons, compared with fellows, had a significantly lower unscrolling times for both younger donors (2.4 +/- 2.3 vs. 4.6 +/- 3.9 min, P = 0.002) and older donors (2.5 +/- 2.1 vs. 3.7 +/- 3.3 min, P <0.001). Rebubble rates were not statistically different between younger (12.3%) and older donors (15.0%, P = 0.527). Three-month ECD was higher in grafts from younger compared with that in those from older donors (2138 +/- 442 vs. 1974 +/- 470 cells/mm(2), P = 0.024). Six-month ECD was similar for younger (1972 +/- 509 cells/mm(2)) and older donors (1947 +/- 460 cells/mm(2), P = 0.585). There was no difference in 3- or 6-month ECL comparing younger (3-mo: 24.3% +/- 13.4%; 6-mo: 31.1% +/- 15.2%) with older donors (3-mo: 25.9% +/- 15.5%, P = 0.489; 6-mo: 27.8% +/- 15.1%, P = 0.231). Conclusions: DMEK grafts prepared from younger donors exhibited similar unscrolling times, rebubble rates, and 3- and 6-month ECL compared with older donors. Experienced surgeons might begin to accept DMEK grafts from younger donors with confidence.