Comparative Evaluation Of Intraoperative Parameters In Penetrating Keratoplasty Using Pre-Punched Versus Conventionally Prepared Donor Corneas In Keratoconus

To assess and compare intraoperative parameters of penetrating keratoplasty (PKP) performed with pre-punched donor corneas prepared in an eye bank and conventionally prepared donor corneas in patients with keratoconus.

A retrospective–prospective comparative study included 60 patients (60 eyes) with stage II–III keratoconus according to the Amsler–Krumeich classification. Patients were divided into two equal groups.

In the study group (n=30), PKP was performed using pre-punched donor corneas prepared in a certified eye bank. In the control group (n=30), donor corneas were manually prepared intraoperatively by the surgeon.

All procedures were performed by the same surgeon using a standardized surgical technique with trephine diameters of 7.5–8.0 mm and continuous 10-0 nylon suturing. Evaluated intraoperative parameters included graft preparation time, total operative time, intraoperative complications, need for additional sutures, graft centration disturbances, intraoperative aqueous leakage, loss of graft transparency, and surgeon-reported procedural convenience assessed using a 5-point scale.

Statistical analysis was performed using Student’s t-test and Pearson’s χ² test, with p<0.05 considered statistically significant.

Graft preparation time was significantly shorter in the pre-punched group compared with the conventional group (3.2 ± 0.9 vs 5.2 ± 1.1 minutes, p=0.021). Total operative time was also significantly reduced when pre-punched donor corneas were used (44.7 ± 5.6 vs 48.1 ± 6.2 minutes, p=0.037).

Surgeon-reported procedural convenience was significantly higher in the pre-punched group (4.6 ± 0.5 vs 3.4 ± 0.6, p=0.014). Although the incidence of intraoperative complications did not differ statistically between groups, a consistent trend toward fewer technical difficulties, including improved graft centration and reduced need for additional sutures, was observed in the pre-punched group.

The use of pre-punched donor corneas in penetrating keratoplasty for keratoconus significantly improves intraoperative efficiency and surgical convenience without increasing the risk of intraoperative complications, supporting the technical advantages of standardized eye-bank–prepared grafts.