Published online Nov 12, 2014. doi: 10.5318/wjo.v4.i4.160
Revised: July 18, 2014
Accepted: September 4, 2014
Published online: November 12, 2014
Deep anterior lamellar keratoplasty (DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty (PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.
Core tip: Deep anterior lamellar keratoplasty (DALK) is recently used for treating corneal diseases not affecting the corneal endothelium. This makes it possible to use donor tissue with poor endothelium. Furthermore, DALK allows acellular corneal tissue to be used and long-term preservation techniques are being considered as a method for donor storage. The recent alterations may require eye banks and corneal surgeons to reassess their selection criteria to ensure donor grafts which are inappropriate for penetrating keratoplasty because of low endothelial cell count can be safely used for DALK.