Randomized, Prospective, Single-Masked Clinical Trial of Endothelial Keratoplasty Performance With 2 Donor Cornea 4°C Storage Solutions and Associated Chambers

Purpose: The aim of this study was to compare endothelial cell loss and graft success 6 months after endothelial keratoplasty (EK) with paired donor corneas stored in Optisol GS and Life4 degrees C solutions and their associated storage chambers. Methods: Donor pairs were stored, one in Optisol GS and the other in Life4 degrees C, and prepared for Descemet stripping automated EK or Descemet membrane EK. Matched pairs of recipients with Fuchs dystrophy were randomized to 1 member of each donor pair. Clarity of recipient stroma, intraocular pressure, and complications were followed for 6 months. Central endothelial images of the donor cornea at screening and 3 and 6 months after EK were analyzed by a masked central reading center. Dual grading of endothelial cell density was performed using the center method. Differences in endothelial cell density and cell loss were examined by paired analysis. Results: Thirty-two pairs were enrolled, and 27 were analyzed (5 had improper matching or loss to follow-up). Donor age was 59 +/- 14 years, median death-to-surgery time was 4 days (range, 2-9 days), 6 recipient pairs had Descemet membrane EK, and 21 had Descemet stripping automated EK. Recipient age was comparable in the Optisol GS and Life4 degrees C groups (70 vs. 68 years, respectively, P = 0.46). Six-month central endothelial cell loss did not differ significantly between the Life4 degrees C and Optisol GS groups (18 +/- 18% vs. 20 +/- 20%, respectively, P = 0.55). All recipient corneas were clear at 6 months in both groups. Conclusions: Endothelial cell loss and graft success were comparable at 6 months for paired donor corneas stored in Optisol GS and Life4 degrees C.