Impact of recipient and donor factors on corneal graft clearance: insights from serial anterior segment optical coherence tomography

Purpose

To evaluate how recipient and donor characteristics influence corneal graft clearance, using serial measurements of central corneal thickness (CCT) and central graft thickness (CGT) derived from anterior segment optical coherence tomography (AS-OCT).

Design

Prospective cohort study.

Methods

Seventy-one patients (76 eyes) who underwent corneal transplantation (October 2021–April 2024) were followed for at least six months. Serial AS-OCT scans were used to extract CCT and CGT measurements, which were analyzed using mixed linear regression models with time splines to assess changes over time. These thickness parameters served as surrogate markers of corneal and graft deturgescence, respectively.

Results

Both CCT and CGT (for DSAEK grafts only) decreased significantly up to 3 months post-surgery (β = -1.73 μm/day, SE = 0.12, p < 0.001; β = -0.53 μm/day, SE = 0.05; p < 0.001), stabilizing thereafter (β = 0.063 μm/day, SE = 0.045, p = 0.156; β = 0.02 μm/day, SE = 0.02; p = 0.228). Faster clearance was observed in grafts from younger donor age (<56 years; β = 0.67 μm/day, SE = 0.23; p = 0.004) and those with higher endothelial cell density (ECD ≥3,021 cells/mm²; β = –1.14 μm/day, p = 0.001). Penetrating keratoplasty was associated with slower CCT reduction compared to Descemet stripping automated endothelial keratoplasty (β = 0.74 μm/day, SE = 0.32; p = 0.021). Other preoperative factors did not significantly influence clearance

Conclusion

CCT and CGT are useful quantitative markers of corneal graft clearance. Donor age, ECD and surgical technique significantly influence early postoperative dynamics. Serial AS-OCT imaging offers valuable, non-invasive insights into graft behavior that can inform clinical decision-making.