Central corneal opacification resulting from recent chemotherapy in corneal donors

Purpose: Ocular surface disease following penetrating keratoplasty has been shown to increase patient morbidity and adversely affect graft survival. Five cases of dense central subepithelial opacification were noted in keratoplasty patients who received tissue from donors who had chemotherapy prior to death. Cancer-related deaths account for approximately 20% of the cornea donor pool. The purpose of this study was to identify the effect of recent systemic antimetabolite therapy on donor corneas. Methods: Eye bank donor charts of 120 consecutive penetrating keratoplasty donors were retrospectively reviewed for cancer-related deaths. Donors who received chemotherapy prior to death were identified. Recipient records of those patients receiving tissue from donors that had recently undergone systemic chemotherapy were reviewed. Corneal clarity and postoperative ocular surface disease were noted by the surgeon. Results: Twenty-nine of 120 cornea donors (24%) had a cancer-related cause of death. Five of these 29 donors (17%) had undergone systemic chemotherapy with antimetabolite drugs (which inhibit microtubule formation) within the previous 8 weeks. All 5 recipients postoperatively developed central subepithelial opacification in spite of temporary tarsorrhaphy performed at the time of keratoplasty. Central corneal opacification was severe enough in 3 patients to require regrafting for visual improvement. Histopathology showed abnormality of the central epithelial basement membrane, apoptosis of basal epithelial cells, and thinning of the epithelial cell layer. Conclusion: Corneas from donors who received a full course of recent systemic antimetabolite therapy are associated with central subepithelial scarring following keratoplasty. Corneal surgeons should be aware of the potential for severe ocular surface disease when using donor tissue from patients with metastatic cancer.