To report the incidence of epithelial defects and identify any predisposing donor factors.

In this retrospective study, 283 consecutive keratoconic eyes underwent DALK using donor corneas of different qualities. On the first postoperative day, the corneal surface was carefully examined and the patients were followed daily until complete re-epithelialization. A multivariate regression analysis was used to assess the correlation between donor characteristics and graft epithelial defects on postoperative day 1.

The mean donor and recipient ages were 33.5±13.2 and 27.6±7.9 years, respectively. Two hundred sixty-four (93.3%) grafts had epithelial defects on day 1. The epithelial defects completely healed after 3.5±2.7 (range, 1 to 37) days. In the univariate analysis, the presence of epithelial defects on postoperative day 1 had a significant correlation with donor preservation-to-surgery time (P=0.01), epithelial sloughing (P<0.001) and graft rating (P=0.004). In the multivariate analysis, only donor epithelial sloughing significantly influenced the presence of epithelial defects on postoperative day 1 (odds ratio=9.26, P<0.001).

Graft epithelial defects were very common following DALK. The epithelial status of donors was the only independent factor predictive of the surface integrity on the first postoperative day.