To determine the effect of donor features on visual and refractive outcomes as well as complications following a deep anterior lamellar keratoplasty (DALK) in keratoconus.

In this retrospective study, 290 consecutive keratoconic eyes underwent DALK using donor corneas of different qualities. Donor data included age and sex, death-to-preservation time, preservation-to-surgery time, epithelial and stromal status, endothelial cell density and morphology, and graft rating. Postoperative outcomes included visual acuity, refractive error, epithelial problems, suture-related complications, graft rejection, and graft transparency.

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 correlations with any donor factors.

Using low-quality donors for DALK increased the rate of epithelial defects and stromal edema. The donor features had no influence on visual and refractive outcomes.