[Suitability of newborn donor corneal graft in penetrating keratoplasty].

OBJECTIVE The lower recommended age of the donor cornea is a controversial matter. Although newborn corneas have a high endothelial cell density, there are anatomical, refractive (myopic shift) and postoperative problems. Two cases are analyzed; one had an atypical refractive result and the other an unexpectedly severe immune response. We also review the use of pediatric donor corneas in penetrating keratoplasty. METHODS Two young patients with keratoconus, in whom a penetrating keratoplasty was done using a 4-month-old newborn corneal donor with high endothelial cell density (4.500 cell/mm2) are reported. RESULTS In the early postoperative period, both had high hypermetropy with weak astigmatism that improved over the next few months. In one patient a marked increase in the astigmatism after removal of the continuous suture was observed. One and a half years after the penetrating keratoplasty there was V=1 corrected vision and the endothelial population was almost unchanged (4,300 cell/mm2). The other patient suffered an allograft reaction with corneal oedema in the seventh postoperative month, and subsequent rupture of the continuous suture made its early removal necessary. The oedema partially diminished with high doses of steroids, but still persisted eighteen months later. CONCLUSION The newborn corneal graft might have led to an early strong hypermetropy as opposed to the supposed myopic shift referred to in the literature. The extremely rapid healing seen in young recipients may lead to early loosening of the continuous suture. High endothelial cell density increases the risk of irreversible graft failure probably due to a high antigenic response. The use of a newborn donor cornea is questionable due to unpredictable refractive and immunological responses.