The influence of Australian eye banking practices on corneal graft survival

Miriam C Keane, Marie T Lowe, Douglas J Coster, Graeme A Pollock and Keryn A Williams
Med J Aust 2013; 199 (4): 275-279. || doi: 10.5694/mja12.11584


Objective: To identify eye banking practices that influence corneal graft survival.

Design, setting and participants: Prospective cohort study of records of 19 254 followed corneal grafts in 15 160 patients, submitted to the Australian Corneal Graft Registry between May 1985 and July 2012.

Main outcome measures: Influence of corneal preservation method (organ culture, moist pot, Optisol, other); death-to-enucleation, death-to-preservation and enucleation-to-graft times; transportation by air; graft era; and indication for graft on probability of graft survival at most recent follow-up.

Results: In multivariate analysis, 919 penetrating grafts performed using corneas transported interstate by air exhibited worse survival than 14 684 grafts performed using corneas retrieved and used locally (hazard ratio [HR], 1.44; 95% CI, 1.21–1.73; P = 0.001). This was also the case for traditional lamellar grafts (64 corneas transported by air and 813 used locally; HR, 1.69; 95% CI, 1.03–2.78; P = 0.038). Indication for graft influenced survival of penetrating grafts (4611 keratoconus, 727 emergency or high-risk, 10 265 other indication; global P < 0.001) and traditional lamellar grafts (65 keratoconus, 212 emergency or high-risk, 600 other indication; global P < 0.001). The preservation medium in which corneas used for traditional lamellar grafts were stored exerted a marginal influence on graft survival (global P = 0.047).

Conclusions: Donor corneas transported interstate exhibited poorer survival after transplantation than those retrieved and grafted locally. Higher proportions of emergency procedures involving transported corneas did not account for this difference. Where possible, efforts to avoid transportation of corneal tissue by air freight within Australia may be warranted.

  • Miriam C Keane1
  • Marie T Lowe1
  • Douglas J Coster1
  • Graeme A Pollock2
  • Keryn A Williams1

  • 1 Department of Ophthalmology, Flinders University, Adelaide, SA.
  • 2 Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC.


We thank Victoria Jones for data entry and validation. We appreciate the voluntary contribution of information by over 700 Australian ophthalmologists and all Australian eye banks. The Australian Corneal Graft Registry is supported by the Australian Organ and Tissue Donation and Transplantation Authority (DonateLife). Keryn Williams is supported by the National Health and Medical Research Council.

Competing interests:

Graeme Pollock is the Director of the Lions Eye Donation Service in Victoria and thus performs the corneal collection, preservation and distribution practices outlined in this study for corneas donated in Victoria.

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