Splitting a single cornea for transplantation into two recipients can reduce the donor shortage and the costs of corneal transplantation surgery, researchers from Germany report in the August 17th Ophthalmology online.

“Our short-term results using split cornea transplantation technique show great promise,” Dr. Ludwig M. Heindl from Friedrich-Alexander University Erlangen-Nurnberg told Reuters Health by email. “The visual results for the patients are at least equal” to results of penetrating keratoplasty.

Dr. Heindl and colleagues describe their initial experience with 12 consecutive split donor corneas. Each was split for same-day transplantation into a patient with a keratoconus (in combination with deep anterior lamellar keratoplasty, or DALK) and a patient with Fuchs’ endothelial dystrophy (in combination with Descemet’s membrane endothelial keratoplasty, or DMEK).

In two eyes, accidental macroperforation of Descemet’s membrane required conversion to penetrating keratoplasty, but split donor cornea preparation was performed successfully in all 10 of the remaining cases.

In the 10 eyes with successful DALK, mean best spectacle-corrected visual acuity (BSCVA) improved from 20/131 to 20/35, mean spherical equivalent improved from -3.5 diopters (D) to -1.4 D, and mean refractive astigmatism decreased from 2.6 D to 1.3 D.

Similarly, in the 10 eyes treated with DMEK, mean BSCVA improved from 20/100 to 20/31. Mean spherical equivalent changed only slightly from 0.5 to 0.6 D, as did mean refractive astigmatism (from 0.5 to 0.6 D).

In the 2 eyes for which penetrating keratoplasty was necessary during DALK, BSCVA averaged 20/50, mean spherical equivalent was -0.3, and mean refractive astigmatism was 0.3 D.

The authors point out that in this small study, the use of split cornea transplantation saved a total of 10 donor corneas.

“Now, we are implementing split cornea transplantation in our clinical routine treating patients with anterior and posterior corneal diseases,” Dr. Heindl said. “Further aims include enlarging the spectrum of diagnoses applicable for the split cornea approach and extending the time between the DALK and DMEK procedure.”

He added that he and his colleagues hope to make split transplantation — already common with liver transplants — a routine procedure in ophthalmology as well.