To evaluate the difference between corneal endothelial cell density at the moment of preservation and at keratoplasty in imported donor corneas and to analyze the correlated factors of the difference.

Eighty-seven imported corneas were evaluated. Corneal endothelial cell density at the moment of preservation was obtained from the medical record and was measured just before the keratoplasty. Correlation of the difference in endothelial cell density with the following factors were analyzed; donor sex, donor age, death-to-preservation time, preservation-to-surgery time, death-to-surgery time, endothelial cell density at the moment of preservation, and preservation period of the corneas.

All of the corneas showed a decrease in endothelial cell density. Mean endothelial cell density of imported donor corneas at the moment of preservation and at keratoplasty was 2789 ± 235 cells/mm² and 2592 ± 254 cells/mm² ( p < 0.001), respectively. Mean endothelial cell loss was 197 ± 148 cells/mm², which was significantly correlated with preservation-to-surgery time, death-to-surgery time and a preservation period longer than 7 days ( p = 0.042, p = 0.045, p = 0.036, respectively).

Reduced death-to-surgery time and keratoplasty before 7 days of preservation are needed for better surgical outcome.