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Purpose Keratorefractive procedures have increased significantly over the past decades, leading to a rising concern about the inadvertent transplantation of donor corneal tissue that may have undergone such procedures or may present with corneal abnormalities such as subclinical keratoconus. These conditions can result in unexpected refractive outcomes postoperatively, yet they are not always detectable with the slit lamp examinations typically used in eye banks. In this context, we have continued to utilize anterior segment optical coherence tomography (AS-OCT) as a non-invasive and sterile method in eye banks to detect corneal grafts with curvature and/or thickness abnormalities. This evaluation provides an update on the ongoing assessment of AS-OCT’s effectiveness and reliability in this critical application.Methods A total of 1864 donor corneal tissues, mounted in sterile tissue cultivation flasks, were imaged using AS-OCT (CASIA2). The tissues were initially preserved in organ culture medium I and then transferred to organ culture medium II, containing 6% dextran T-500, for deswelling for at least 24 hours prior to imaging and subsequent keratoplasty. Depth raster scans were conducted across the posterior surface of the corneal tissues within a central 7 mm zone to generate 3D volumetric data. This data set was subsequently preprocessed to remove artifacts caused by flask reflections and to delineate the region of interest (ROI). A sphero-cylindrical surface model was then applied using ray tracing techniques, allowing for the determination of the curvature radii of both the anterior and posterior surfaces, and facilitating the creation of a detailed corneal thickness map.Results The mean radius of curvature for the steep and flat anterior corneal surfaces was 7.74 ± 0.25 mm (range: 5.07 – 9.29 mm) and 7.70 ± 0.23 mm (range: 6.70 – 9.50 mm), respectively. For the posterior corneal surfaces, the corresponding mean values were 6.46 ± 0.32 mm (range: 5.00 – 8.00 mm) and 6.80 ± 0.31 mm (range: 5.81 – 8.00 mm). The mean central corneal thickness was 608.4 ± 79.5 μm, with a range of 378.5 to 1457.2 μm. Abnormalities, defined as values outside ± 2 standard deviations (SD) or ± 3 SD from the mean, were identified in 170 corneas (9.1%) or 45 corneas (2.4%) for the anterior surface curvature, 158 corneas (8.5%) or 37 corneas (2%) for the posterior surface curvature, and 80 corneas (4.3%) or 17 corneas (0.9%) for central corneal thickness. A total of 99 (5.3%) corneas were therefore not used for a penetrating Keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK).Conclusion AS-OCT still offers a reliable, sterile, and potentially semi-automated screening tool, enabling the identification of corneal morphological and refractive alterations, such as keratoconus or post-PRK/LASIK changes. This method enhances the selection process of corneal donors in eye banks. Donor corneas exhibiting curvature or thickness abnormalities beyond ±3 SD do not necessarily need to be discarded but can still be utilized for posterior lamellar keratoplasty, particularly for DMEK in Germany.