Showing papers on "Eye bank published in 2020"

Early Impact of COVID-19 Outbreak on the Availability of Cornea Donors: Warnings and Recommendations

Abstract: Keratoplasty is one of the irreplaceable treatment options for corneal diseases. Currently, there is no evidence to substantiate that harvested corneal grafts from COVID-19 patients can contain SARS-CoV-2 virus and lead to a systemic infection. Although the risk of transmission through corneal stromal tissue is low, it potentially exists. Lack of clinical data, unclear potential of donor-derived infection and non-established recommendations for transplantation during the COVID-19 pandemic have resulted in a dramatic reduction in the number of keratoplasty and cornea donors at ophthalmology departments and eye banks. To eliminate the risk of infection of recipients and medical personnel, we suggest that the blood samples of all donors should be screened with RT-PCR tests and nasopharyngeal swabs should be taken. In addition, a chest CT scan should be performed if the circulation is maintained. Moreover, the donors' clinical and epidemiological medical history must be screened for typical symptoms and potential contact with SARS-CoV-2 carriers to reduce the risk of transmission. The Guidelines of the Eye Bank Association of America (EBAA), Global Alliance of Eye Bank Associations (GAEBA) and European Association of Tissue Banks provide useful recommendations to eliminate the risk of transmission according to previous experiences based on similar viruses.

Thirty years of eye bank experience at a single centre in India.

Abstract: The global survey of eye banking and corneal transplantation reveals differences in eye banking trajectories in various countries. There is a need to encourage and lay down foundations of successful eye banking practices in many nations across the world map. The study evaluates demographics, trends in donor cornea retrieval, utilization and eye banking practices in over 30 years at a single eye bank in India. A longitudinal descriptive analysis of eye banking practices from 1989 to 2018 at Ramayamma International Eye Bank, Hyderabad, India, was performed. Data on eye donations, practice patterns and various types of keratoplasty were collected. Data were analysed focusing on practices and historical development of the eye bank. Over the years, the eye bank has made use of several advances in its practice patterns and evolved to a stage of self-sustainability. With the fulfilment of internal demand for corneal transplantation, 50% of retrieved corneas could be distributed for community needs outside the institute. Number of transplants increased from 20 in 1987 to 4738 in 2018. Total number of transplants touched 27,746 in 2018 which might be the highest numbers for a single centre anywhere in the world. The study reveals a dynamic development of the eye bank over the last 30 years and emphasizes the importance of an active quality management in coping with the challenges of modern eye banking. The increasing trend of cornea collection and transplantation is a reflection of the needs and efforts towards treating and eliminating corneal blindness.

Eye bank versus surgeon prepared DMEK tissues: influence on adhesion and re-bubbling rate

Abstract: AIM: To investigate the difference in adhesion and rebubbling rate between eye bank and surgeon prepared Descemet membrane endothelial keratoplasty (DMEK) tissues. METHODS: Laboratory and clinical retrospective comparative interventional case series. Research corneal tissues were obtained for laboratory investigation. The clinical study involved patients with endothelial dysfunction who underwent DMEK surgery and tamponade with air. Tissues were stripped using a standard DMEK stripping technique (SCUBA) and shipped as prestripped or loaded in a 2.2 intra-ocular lens cartridge with endothelium facing inwards (preloaded) before transporting from the eye bank to the surgeon. For surgeon prepared tissues, all the grafts were stripped in the theatre and transplanted or stripped in the laboratory and tested immediately. Adhesion force and elastic modulus were measured in the centre and mid-periphery in a laboratory ex vivo investigation using atomic force microscopy, while rebubbling rates were recorded in the clinical study. RESULTS: There was no difference in endothelial cell viability between surgeon or eye bank prepared tissue. Surgeon-stripped DMEK grafts in the laboratory investigation showed significantly higher elastic modulus and adhesion force compared to prestripped and preloaded tissues (p<0.0001). In the clinical data, rebubbling rates of 48%, 40% and 15% were observed in preloaded, prestripped and surgeon-stripped DMEK grafts, respectively. Rebubbling rates were significantly associated with combined cataract surgery (p=0.009) and with time from harvesting the graft to the surgery (p=0.02). CONCLUSIONS: Decreased adhesion forces and elastic modulus in eye bank prepared tissues may contribute to increased rebubbling rates.

All India Ophthalmological Society - Eye Bank Association of India consensus statement on guidelines for cornea and eyebanking during COVID-19 era.

Abstract: The COVID-19 pandemic has brought with it the huge burden of mortality and morbidity across the world and the added effects of the mandatory lockdown measures to try and control the spread A number of aspects of healthcare including eye donation and eye collection require adequate safety precautions in place to keep both the involved healthcare workers and patients safe This paper highlights the consensus-based guidelines by an expert panel on how to restart eye banking and eye collection services and carry out emergency corneal surgeries during this COVID-19 time These guidelines will be applicable to all eye banks across the country and should help ophthalmologists and eye banking staff to restart eye banking while safeguarding themselves and their patients

Eye Banking: One Cornea for Multiple Recipients.

Abstract: Purpose Corneal transplantation is the most frequently performed transplant procedure. In much of the world, the demand for donor tissue heavily outstrips supply. With developments within lamellar corneal graft surgery, the use of split corneal donor tissue to increase donor tissue supply seems a pragmatic solution to reduce the supply and demand mismatch. This is especially important with tissue supply expected to be affected by the COVID-19 pandemic. Methods A literature review of techniques was performed, enabling multiple transplants to be derived from a single donor and simulation of a model to quantify the number of corneas potentially saved. Results Studies on splitting corneal donor tissue have demonstrated that up to 5 recipients may benefit from 1 donor scleral button. The impact of splitting donor tissue may provide a saving of up to 25.3% of donor graft tissue. Conclusions Splitting and preparing the donor tissue within an eye bank will improve tissue validation and donor tissue availability and may increase surgeon efficiency.

Survey report on keratoplasty in China: A 5-year review from 2014 to 2018

Abstract: To provide the general information on corneal transplantation (CT) in China, China Cornea Society designed a questionnaire on CT from 2014 to 2018 and entrusted it to 31 committee members for implementation of the survey nationwide. This article presents the results of the survey and compares the indicators used in the survey and those in the annual statistical report released by the Eye Bank Association of America (EBAA). The number of corneal transplantations completed by the 64 hospitals from 2014 to 2018 was respectively 5377, 6394, 7595, 8270 and 8980, totally 36,616 (22,959 male and 13,657 female). The five largest hospitals by the number of corneal transplantations completed 15,994 surgeries in total, accounting for 43.68% of all the surgeries performed in the 64 hospitals. The most common indication for corneal transplantations was corneal leukoma (7683, 20.98%), followed by bacterial keratitis (4209, 11.49%), corneal dystrophies (4189, 11.44%), keratoconus (3578, 9.77%) and corneal perforation (2839, 7.75%). The main surgical techniques were penetrating keratoplasty (PK) (19,896, 54.34%), anterior lamellar keratoplasty (ALK) (13,869, 37.88%). The proportion of PK decreased from 57.97% in 2014 to 52.88% in 2018 while the proportion of ALK increased from 36.04% in 2014 to 37.92% in 2018. The geographical distribution of keratoplasties performed in China is unbalanced. PK and ALK were the main techniques of CT and corneal leukoma, bacterial keratitis and corneal dystrophies were the main indications for CT in China.

In Vivo Confocal Microscopy of Stromal Lenticule Addition Keratoplasty for Advanced Keratoconus.

Abstract: Purpose To investigate the in vivo corneal microscopic changes after femtosecond laser-assisted stromal lenticule addition keratoplasty in keratoconus by means of in vivo confocal microscopy. Methods Patients affected by advanced keratoconus were included in the study. Negative meniscus-shaped stromal lenticules, produced with a femtosecond laser (VisuMax; Carl Zeiss Meditec) from eye bank corneas were transplanted into a stromal pocket dissected in the recipient cornea at a depth of 120 µm. In vivo confocal microscopy was performed during the 12-month follow-up to investigate changes of the corneal and lenticule structure. Results Ten patients were enrolled in the study. No changes of the dendritic cell population were documented during the follow-up period. Mild edema and stromal keratocyte activation gradually decreased during the first month. Subbasal nerve density returned to preoperative values after 6 months. Donor-recipient interfaces appeared hyperreflective but gradually improved over time with significantly reduced reflectivity after 3 months. No evidence of stromal inflammatory cell migration or matrix opacification was observed. Endothelial and keratocyte density remained stable over time. A variable degree of stromal radially distributed folds, not visible on biomicroscopy, was observed in the lenticule and in the posterior recipient stroma. Conclusions Stromal lenticule addition keratoplasty produces transitory nerve plexus density reduction and minor inflammatory reaction that rapidly decreases during the first month. Donor-recipient interface reflectivity is comparable to a femtosecond laser refractive procedure with no sign of stromal opacification or stromal rejection in 1 year of follow-up. [J Refract Surg. 2020;36(8):544-550.].

Prevalence of SARS-CoV-2 in human post-mortem ocular tissues.

Abstract: Background SARS-CoV-2 is found in conjunctival swabs and tears of COVID-19 patients. However, the presence of SARS-CoV-2 has not been detected in the human eye to date. We undertook this study to analyze the prevalence of SARS-CoV-2 in human post-mortem ocular tissues. Methods The expression of SARS-CoV-2 RNA was assessed by RT-PCR in corneal and scleral tissues from 33 surgical-intended donors who were eliminated from a surgical use per Eye Bank Association of America (EBAA) donor screening guidelines or medical director review or positive COVID-19 test. Ocular levels of SARS-CoV-2 RNA (RT-PCR), Envelope and Spike proteins (immunohistochemistry) and anti-SARS-CoV-2 IgG and IgM antibodies (ELISA) in blood were evaluated in 10 COVID-19 donors. Findings Of 132 ocular tissues from 33 surgical-intended donors, the positivity rate for SARS-CoV-2 RNA was ∼13% (17/132). Of 10 COVID-19 donors, six had PCR positive post-mortem nasopharyngeal swabs whereas eight exhibited positive post-mortem anti-SARS-CoV-2 IgG levels. Among 20 eyes recovered from 10 COVID-19 donors: three conjunctival, one anterior corneal, five posterior corneal, and three vitreous swabs tested positive for SARS-CoV-2 RNA. SARS-CoV-2 spike and envelope proteins were detected in epithelial layer of the corneas that were procured without Povidone-Iodine (PVP-I) disinfection. Interpretations Our study showed a small but noteworthy prevalence of SARS-CoV-2 in ocular tissues from COVID-19 donors. These findings underscore the criticality of donor screening guidelines, post-mortem nasopharyngeal PCR testing and PVP-I disinfection protocol to eliminate any tissue harboring SARS-CoV-2 being used for corneal transplantation. Funding Research grant from EBAA and National Institutes of Health.

Comparisons of Cornea Cold, a New Corneal Storage Medium, and Optisol-GS.

Abstract: Purpose This study compares the quality of donor corneal tissue stored in Optisol-GS and Cornea Cold. Methods Seventeen pairs of donor corneas were obtained from an eye bank. One of each pair was stored in Cornea Cold or Optisol-GS. Endothelial cell loss (ECL), central corneal thickness (CCT), and endothelial cell density (ECD) were measured at 7 and 21 days of storage. Qualitative metrics were evaluated by using a slit lamp. Results At days 7 and 21, there were no observed differences in qualitative corneal health of the samples. There were no statistical differences in the mean ECL at 7 and 21 days between the 2 groups (P = 0.07 and P = 0.50, respectively). At 7 days, the mean CCT was 644 ± 52 μm in the Cornea Cold group and 591 ± 64 μm in the Optisol-GS group (P = 0.001). At 21 days, CCT was 714 ± 55 μm in the Cornea Cold group and 708 ± 58 μm in the Optisol-GS group (P = 0.70). The mean ECD was not statistically different between the groups (P = 0.56 at 7 days and P = 0.14 at 21 days). Conclusions Storage of corneal donor tissue in the Optisol-GS and Cornea Cold storage media resulted in statistically comparable ECL and ECD for up to 21 days. CCT was higher in Cornea Cold at 7 days, but this discrepancy disappeared at 21 days.

Performance of New Hypothermic Corneal Storage Media With an Antimycotic Tablet in Comparison to Traditional Hypothermic Media During Simulated Eye Bank Processing.

Abstract: Purpose To compare the performance of Kerasave (AL.CHI.MI.A. S.R.L., Ponte San Nicolo, Italy) containing 2.5 μg/mL of amphotericin B and Optisol-GS (Bausch & Lomb, Bridgewater, NJ) cold corneal storage media on donor corneas during routine eye bank procedures. Methods Forty-four paired donor corneas were preserved after swab sample collection and povidone-iodine decontamination. Right and left corneas were immersed in Kerasave and Optisol-GS, respectively, and stored at 4°C before the initial evaluation. Paired corneas were assigned to processing subgroups for penetrating keratoplasty (n = 20), Descemet stripping automated endothelial keratoplasty (n = 14), or Descemet membrane endothelial keratoplasty (n = 10). Endothelial cell density, central corneal thickness, slit-lamp examination, and endothelial cell damage were assessed at different intervals. Sterility testing was performed on media samples. Results At the initial evaluation, after 25.6 ± 3.2 hours of storage, the mean central corneal thickness of all corneas in Kerasave (n = 22) was greater than those in Optisol-GS (n = 22) (571 ± 12 μm vs. 526 ± 10 μm, respectively; P = 0.006). All other metrics were comparable between Kerasave and Optisol-GS in processing subgroups at all time intervals. Corneal swabs were positive in 90% of corneas before decontamination with povidone-iodine. At the initial evaluation, fungal contamination was detected in 24% and 19% of Kerasave and Optisol-GS, respectively. At the final evaluation, no fungi was detected in Kerasave and 1 Optisol-GS sample was positive (P = 0.999). Conclusions Metrics of corneas stored in Kerasave and Optisol-GS were comparable. Kerasave might be considered an antifungal-possessing alternative to Optisol-GS.

Research Progress of the Application of Hypothermia in the Eye.

Abstract: Hypothermia is widely used in the medical field to protect organs or tissues from damage. Different research fields have different explanations of the protection mechanism of hypothermia. Hypothermia is also widely used in the field of ophthalmology, for example, in the eye bank, the preservation of corneal tissue and the preservation of the eyeball. Low temperature can also be applied to some ophthalmic diseases, such as allergic conjunctivitis, retinal ischemia, and retinal hypoxia. It is used to relieve eye symptoms or reduce tissue damage. Hypothermic techniques have important applications in ophthalmic surgery, such as corneal refractive surgery, vitrectomy surgery, and ciliary body cryotherapy for end-stage glaucoma. Hypothermia can reduce the inflammation of the cornea and protect the retinal tissue. The eyeball is a complex organ, including collagen tissue of the eyeball wall and retinal nerve tissue and retinal blood vessels. The mechanism of low temperature protecting eye tissue is complicated. It is important to understand the mechanism of hypothermia and its applications in ophthalmology. This review introduces the mechanism of hypothermia and its application in the eye banks, eye diseases (allergic conjunctivitis, retinal ischemia, and hypoxia), and eye surgeries (corneal transplant surgery, corneal refractive surgery, and vitrectomy).

A 27-Year Report from the Central Eye Bank of Iran.

Abstract: Purpose: To report the 27-year statistical data from the Central Eye Bank of Iran (CEBI) and its activity. Methods: All CEBI records regarding procured eyes, tissue utilizations, corneal transplants per capita, and indications for keratoplasty from 1991 to 2017 were analyzed. Results: In total, 115,743 whole eyes were donated during the 27-year period. Out of the 114,169 eyes donated between 1994 and 2017, 95,314 eyes were distributed for transplantation, and 95,057 corneas were actually transplanted. The mean annual rate of corneal transplants per capita was 55.10−6 ± 27.10−6. Although penetrating keratoplasty (PKP, 70%) was the most common technique of corneal transplantation during the study period, it exhibited a decreasing trend between 2006 and 2017 (P = 0.048). It was in contrast to Descemet stripping automated endothelial keratoplasty (DSAEK) that demonstrated an increasing trend during the same period (P < 0.001). Keratoconus (KCN, 39.70%) was the most leading indication for keratoplasty over the last three decades followed by bullous keratopathy (BK, 18.5%), corneal scar and opacities (15.7%), and graft failure (GF, 7.5%), with an increasing trend for BK, GF, and KCN. A majority of scleral tissues (83.7%) were utilized for orbital implant protection. Conclusion: An increasing trend in the number of procured eyes was observed over the past 27 years in Iran. The most leading indications for corneal transplantation were KCN and BK. While PKP was the most common keratoplasty technique, DSAEK showed an increasing trend over the last 12 years.

Effect of manual, preloaded, and automated preloaded injectors on corneal incision architecture after IOL implantation.

Abstract: PURPOSE To analyze the effects on corneal morphology of manual, preloaded, and automated preloaded intraocular lens (IOL) injectors in eye bank human corneas by environmental scanning electron microscopy (ESEM) and in patients after phacoemulsification using anterior segment optical coherence tomography (AS-OCT). SETTINGS Eye Clinic, Careggi University Hospital, Florence, Italy. DESIGN Retrospective and experimental study. METHODS Seventy-eight corneal incisions were examined after IOL implantation: 30 in human corneas mounted on an artificial chamber using ESEM (ex vivo); 48 in patients undergoing phacoemulsification (in vivo). Three different injectors were used for both analyses: manual (Monarch III, n = 26), manual preloaded (UltraSert, n = 26), and automated preloaded system (AutonoMe, n = 26). Thirty IOLs were implanted in the ex vivo study: 5 intermediate and 5 high dioptric powers for AcrySof IQ (Monarch and UltraSert) and for Clareon (AutonoMe) IOLs. In the in vivo analysis, 16 corneal wounds for each injector were evaluated using AS-OCT; in the ex vivo study, incision width was measured and Descemet membrane detachment, posterior wound retraction, and posterior gape were analyzed. RESULTS In the eye bank corneas, the incision width was significantly wider in the high dioptric power IOL manual subgroup (P < .05), with more Descemet tearing compared with AutonoMe. In the in vivo study, the incidence of Descemet membrane detachment, posterior gape, and wound retraction was lower in the automated preloaded group at 1 postoperative day 1. CONCLUSIONS The automated preloaded injector ensured less trauma to the wound and contributed to preserving the endothelial side of the incision even during the implantation of high-power IOLs and in the early postoperative period.

Donor Profile, Tissue Evaluation and Comparison of Voluntary and Motivated Corneal Donation in Nepal Eye Bank.

Abstract: Purpose Corneal problems is one of the major causes of blindness in developing countries like Nepal. This study intended to analyze donor and tissue profile of Nepal Eye Bank (NEB). Material and methods This was a cross-sectional descriptive type study. Data of corneal tissues collected by NEB from January 2015 to December 2016 were used in the study. Data collected were demographic profile, cause of death, type of corneal donation (whether voluntary or motivated), quality and utilization of tissues. A comparison was made between voluntary and motivated donors. Results 1244 corneal tissues were retrieved from 639 donors. Mean age of donors was 49.4 years. 57.7% of the donors were male. There were almost equal number of donor deaths due to cardiovascular disease, 27.2%, and respiratory disease, 26.7%, followed by hanging, 17.8%. Majority of donors were motivated (n = 561, 87.7%). Mean death to preservation time was 5.79 hours (hrs). Of the harvested corneas, 1040 (83.6.%) were suitable for transplant with a mean endothelial cell count of 2850 ± 520 cells/mm2; 16.4% were of poor tissue quality and 2.7% were seropositive. 76.2% of total tissues were of optical quality. Utilization rate of transplantable tissues was 97%. Tissues from motivated donors were significantly "younger" (p=0.0001), had better endothelial count (p=0.0001), and were of better quality (p=0.026) than those from voluntary donors. Conclusion Motivated eye donation is a major and effective source of cornea collection in the eye bank under study with "younger" and better quality corneas compared to voluntary donors.

Ethics in Eye Banking: Understanding Professional Attitudes Toward Industry Changes.

Abstract: Purpose:To describe the ethical attitudes of corneal surgeons and eye bank leadership toward for-profit entities in corneal donation, processing, and distribution.Methods:Fifty postfellowship corneal surgeons practicing in the United States and 25 eye bank leaders (eg, eye bank directors, CEOs, or p

Current clinical application of sclera and amniotic membrane for ocular tissue bio-replacement

Abstract: To report the current clinical applications and trends of scleral and amniotic membrane use in ophthalmology. Review of annual reports from the Catalan Transplant Organization (OCATT), on scleral patch and amniotic membrane eye indications in Catalonia region (Spain) over a 6-year period from 2013 to 2018. A total of 874 scleral and 1665 amniotic membranes patches were implanted, from January 2013 to December 2018. The most frequent indication over the 6-year period for scleral patch was glaucoma surgery (77.5%), eyelid reconstruction (5.2%) and corneal or scleral ulcer (5%). Regarding amniotic membrane, corneal ulcer (26.9%), conjunctival reconstruction (23.8%) and corneal epithelial defect (22.7%) were the most common indications. During the study period, an increasing trend was found on sclera patches for eyelid reconstruction (p = 0.0032) and amniotic membrane for inflammation management (p = 0.0198). Glaucoma surgery and corneal ulcers have represented the top indications for scleral patch and amniotic membrane use, over the period, respectively. A significant trend has also been found towards eyelid reconstruction using scleral patches and amniotic membrane for anterior segment inflammation management. This evolving scenario in tissue use for ocular surgery has to be taken into consideration, especially regarding eye banks facing current and futures changes in tissue preservation, storage and indications.

A new approach to extend the storage of donor corneas after 28 days of corneal culture in an Italian eye bank

Abstract: This study aimed to evaluate the possibility to extend the storage of unused organ-cultured donor corneas. After 28 days of corneal culture in TISSUE-C (AL.CHI.MI.A. S.R.L., Italy) and 5-day storage in transport/deswelling medium CARRY-C (AL.CHI.MI.A. S.R.L., Italy), 25 corneas that were deemed suitable for transplantation were transferred in fresh TISSUE-C at 31 °C for additional 7 days and then in fresh CARRY-C at room temperature for 24 h. Tissues were assessed for endothelial cell density (ECD), endothelial mortality and morphology after the standard and the extended corneal storage. In addition, the effect of donor age < 85 years and ≥ 85 years on corneal characteristics was assessed. After the extended storage, 6 out of 25 tested corneas (24%) showed ECD values below the acceptance limit (< 2000 cells/mm2). 19 corneas (76%) were still suitable for transplantation and showed a 5.9% loss in ECD, which was not statistically significant (P = 0.0949) compared to standard storage period. The two donor age groups did not show statistically significant differences in any tested parameter, although a trend for lower ECD and higher mortality in Descemet’s folds after standard storage was observed in the ≥ 85 age donor group. Thus, the attempt of the current study to provide new sight-restorative options for unused tissues and increasing the availability of corneas in case of shortage gave encouraging results. Although a higher vulnerability of corneas from very old donors could not be statistically demonstrated in the present study, higher sample size could be required for prolonging the shelf life of these tissues.

Outcomes of corneal transplantation using donor corneas retrieved from patients with chronic kidney disease

Abstract: Purpose: To report the outcomes of corneal transplantation utilizing corneas retrieved from donors with chronic kidney disease (CKD). Methods: Outcomes of corneal transplantation (optical PK and EK) performed from Jan 2018 to Dec 2018 utilizing donor corneas retrieved from CKD patients was performed retrospectively. Results: Of the total of 233 donor corneas retrieved from CKD, 135 (57.9%) were utilized for transplantation after the routine screening protocol of the eye bank. Mean age of the donors was 56.2 ± 13.5 years. The mean endothelial cell density on specular microscopy of the donor corneas used for optical PK was 2685.7 ± 377.6 cells/mm2 (range, 2028–3448 cells/mm2) and for EK was 2731.7 ± 189.1 cells/mm2 (range, 2380–3194 cells/mm2). The overall primary graft failure rate was 5.1%. All grafts except 1, cleared in the PK group. In the EK group (6 DMEK and 16 DSAEK), 1 patient had a complete graft detachment and another 1 had a primary graft failure after DMEK. Conclusion: The donor corneas retrieved from chronic kidney disease patients are safe and suitable for optical keratoplasty provided they meet the criteria for transplantation.

Vertical Scrolling Axis of Corneal Endothelial Grafts for Descemet Membrane Endothelial Keratoplasty.

Abstract: PURPOSE Heterogeneity in scrolling behavior of Descemet membrane endothelial keratoplasty (DMEK) grafts complicates DMEK surgery. This prospective observational study assessed scrolling axes of DMEK grafts relative to the donor's eye. METHODS The eye bank randomly marked the rim of corneoscleral donor buttons during trephination and recorded the position relative to the donor's axis. Surgeons were masked to the absolute position of the eye bank marking and recorded the scrolling axis relative to the eye bank marking and DMEK upside-down orientation. The scrolling axis was categorized as vertical (0 to 30 degrees and 150 to 180 degrees), oblique (>30 to 60 degrees and 120 to 60 to <120 degrees). Scrolling patterns of corneas from the same donor were assessed. RESULTS Scrolling patterns of 202 donor corneas from 149 donors were determined. The donor graft scrolled predominantly vertically to the donor's cornea [75%; 95% confidence interval (CI), 68%-80%]. Horizontal axes (11%) and oblique axes (14%) were less common. The median deviation in scrolling axes after unfolding the grafts was 0 degrees from the original scrolling axis (interquartile range, 0-15), indicating that scrolling axes were stable. Fellow eyes of 46 donors had 3.55 times higher odds of a nonvertical scrolling pattern if the first eye had a nonvertical scrolling pattern (95% CI, 1.37-9.20), suggesting that donor factors influencing both eyes could contribute to scrolling patterns. CONCLUSIONS DMEK grafts have a natural and stable scrolling tendency at vertical axis of donor's cornea. Anticipating scrolling axes might help improve preparation techniques for DMEK grafts and outcomes.

Practical use of rubric for assessment of eye bank professionals for eye retrieval and its role in improving eye retrieval process in eye banks: An Indo-American experience.

Abstract: Purpose: To study the practical use of the Rubric for Assessment of Eye Bank Professionals for Eye Retrieval (RAEPER) as a competency assessment tool by organizing a workshop in two eye banks – one in India and other in America. Methods: Two-day workshop was conducted in two eye banks – named Shroff's Charity Eye Hospital (SCEH) in India and Miracles in Sight (MIS) in America. Day 1 of workshop comprised of didactic lectures and discussions and day 2 was eye retrieval assessment done on human eyes in a wet lab setting. Assessment was done using RAEPER by two independent senior eye bank managers. Results: MIS had 27 participants, 15 males and 12 females (mean age: 38.8 years, range: 28-55) and SCEH had 11 participants, 10 males and 1 female (mean age: 48 years, range: 22–68). All participants were in house technicians, who had a minimal experience of at least 150 eye retrievals. At MIS, step 19 (crystalline lens check) got a score of 3 (Competent) 93.5% of the time. At SCEH, step 6 (conjunctival removal) and step 4 (Irrigation of cornea with sterile saline) were high scoring with 90.11% and 72.7% scoring 3, respectively. Conclusion: India's cornea blind population is expected to reach 10 million by 2020. Steps need to be taken to improve cornea retrieval rates in the country and make various eye banks self-sufficient. Incorporating such training modules not only improves the cornea utilization rates, but also helps standardize the entire eye banking process.

Proposed risk factors for failure of transplanted eye bank-prepared descemet stripping automated endothelial keratoplasty tissues

Abstract: To investigate the possible risk factors for failure of transplanted eye bank-prepared Descemet stripping automated endothelial keratoplasty (DSAEK) tissues. In a retrospective study between March 2011 and March 2019, all the failed DSAEK cases (131 cases) reported to the Central Eye Bank of Iran were compared with a surgeon-matched successful DSAEK group (control, 126 cases) in terms of the donor, DSAEK tissue, and recipient characteristics. Univariate analysis indicated that the DSAEK tissue preparation from excised corneoscleral tissues (OR 2.17; P = 0.026) and donor conjunctival hyperemia (OR 1.62; P = 0.042) were more common in the re-DSAEK group than in the controls. Other donor and recipient characteristics as well as other DSAEK tissue criteria were not significantly different between the re-DSAEK and control groups. DSAEK lenticules in both re-DSAEK and control groups demonstrated symmetric contours. Subgroup analyses in the re-DSAEK group revealed a higher rate of surgeons’ low to moderate experience in comparison to those of high experience (P < 0.001). Additionally, failed DSAEK was observed more commonly in donors aged over 50 years than among those under 30 years (P < 0.001). Our study showed that DSAEK tissues prepared from excised corneoscleral tissues and from donors with conjunctival hyperemia were associated with higher rates of re-DSAEK due to failed DSAEK. An increasing trend of re-DSAEK was observed with shorter surgeons’ experience and more advanced donor’s age.

Eccentrically Punched Descemet Membrane Endothelial Keratoplasty Grafts Expand the Descemet Membrane Endothelial Keratoplasty Donor Pool: One Eye Bank's Reappraisal of the Central Clear Zone Convention.

Abstract: PURPOSE To ascertain whether offsetting the Descemet membrane endothelial keratoplasty (DMEK) punch can expand the donor pool in conjunction with prepunched and preloaded services by recapturing the corneas otherwise excluded by the conventional central clear zone criteria. METHODS In this retrospective review of corneas recovered and processed for DMEK by a single eye bank between March 2017 and October 2018, corneas failing to meet the conventional central clear zone requirement during initial evaluation (defined as an area in the central cornea where an 7.5- to 8.0-mm diameter graft can be obtained free of previous surgical scars, Descemet tears, or confined areas of endothelial defects) were further evaluated for offset punching. Corneas with a central endothelial cell density of at least 2000 cells/mm at the initial screening (average of 3 specular images assessed with the center dot method) that had a clear zone of 7.5- to 8.0-mm diameter where a graft could be obtained were designated as eligible for offset punching for either prepunched or preloaded DMEK. RESULTS A total of 2607 corneas were found to be suitable for DMEK using the conventional central clear zone criteria. An additional 62 corneas were deemed DMEK suitable by offsetting the punch, yielding a 2.4% increase in the availability of DMEK suitable corneas. CONCLUSIONS Offsetting the DMEK punch can recapture corneas otherwise excluded from the DMEK donor pool because of a failure to meet the conventional central clear zone criteria, and by our estimation may help eye banks meet the growing demand for DMEK tissue while maximizing the transplant potential of every cornea.

Usefulness of Prestorage Corneal Swab Culture in the Prevention of Contaminated Corneal Tissue in Corneal Transplantation.

Abstract: Purpose To assess the efficacy of the prestorage corneal swab (PCS) culture to screen for corneal graft contamination after storage in Optisol-GS. Methods A retrospective analysis of all PCS cultures was performed at the Eye Bank of Quebec in Hopital Maisonneuve-Rosemont from September 2013 to June 2016. Whole corneal culture was performed on rejected grafts because of a positive PCS, and a contamination rate was calculated. In addition, contamination rates of corneoscleral rims were compared between corneas tested with PCS and those of imported corneas which did not have PCS. Results Among the 1966 PCS cultures performed, 814 (41.4%) were positive for growth. Pathogenic bacteria were present in 144 (7.3%) corneas, including Staphylococcus aureus (n = 96, 11.8% of all positive cultures), Enterobacteriaceae (n = 14, 1.7%), and Pseudomonas aeruginosa (n = 6, 0.7%). After preservation in Optisol-GS, only 7 (6.9%) corneas remained contaminated (95% confidence interval 5.1-9.3). The sensitivity of the PCS culture was 87.5% (95% confidence interval 47.4-99.7). There was no significant difference in corneoscleral rim contamination between corneas tested with PCS (1/388; 0.2%) compared with imported, nonswabbed corneas (3/214; 1.4%) (P = 0.131). Therefore, the cost to recover the loss of tissue rejected because of false-positive PCS by purchasing corneal tissue was calculated to be $142,884 (CAD) per year. Conclusions Despite the high sensitivity of PCS cultures, there was no significant reduction of infection after corneal transplantation using this technique. In consequence, 93% of the corneas possibly suitable for transplantation were rejected. This suggests that the PCS culture alone is a poor test for detecting clinically relevant corneal contamination.

A study to evaluate the keratoanalyzer in success of penetrating kertoplasty

Abstract: Aims: To evaluate donor cornea by using eye bank specular microscope and evaluate outcome of keratolplasty according to the graft condition. Materials and Methods: This was a prospective study of 30 patients who undergone keratoplasty. Donor cornea was evaluated by slit lamp biomicroscopy and after preservation in MK media, evaluated using eye bank specular microscope. Final decision of transplantation was made on grading of specular microscopy. All patients undergone penetrating keratoplasty and post-operative outcome was measured. Results: In our study majority of donors were in age group of 21-40 years. Endothelial cell count of >3000 cells/mm2 was observed in 60% cases, while 2500-3000 cells/mm2 in 26.67% cases. The reason for penetrating keratoplasty were corneal opacity or scarring (40%), PBK (23.33%), acute infective keratitis (13.33%), regraft due to graft failure (10%), ABK (10%) and corneal dystrophy (3.33%). Postoperative clear graft was seen in 60% cases while cloudy in 20% and opaque in 20% cases. It was observed that large number of recipients (46.66%) had post-operative visual acuity more than 6/60. Conclusions: Though tissue utilization can be optimized with the use of eye bank specular analyzer, final outcome depends on multiple factors. Few tissues of older age can be utilized if having good endothelial count. Keywords: Corneal blindness, Eye bank specular analyzer, Keratoplasty.

Demographic Profile of Donor Cornea of an Eye Bank in Tertiary Care Hospital in North India- A 9-Year Review

Abstract: Purpose: To study the demographic profile of the donated corneas and eye donation trend of an eye bank in tertiary care hospital in North India. Study DesignRetrospective, non-comparative observational study. Material and MethodsData from 1273 donor eyes collected from all over Haryana under Hospital Cornea Retrieval Programme (HRCP) and those collected from voluntary donors at their residence from April 2011 to March 2020 were analyzed including the demographic features like the cause of death, gender, age, and place of tissue procurement, death-enucleation time &distance from the eye bank. Results: During the study period, 1273 corneas were retrieved from 672 donors, among which 59.2% were males and 40.8% were females, with donor age ranging from 12-102 years. Most of the donors were from nearby districts in Haryana and few from neighbouring state of Punjab. Maximum number of eye donations was in the age group of 51-70 years. Death enucleation time was within 6 hrs from death in majority of the donors. 51.5% of the donor corneas were procured from within 50 kms from the eye bank. 60% of the corneas were collected from home and 40% under HRCP (Hospital corneal retrieval programme). The most common cause of donor death was due to old age (Natural death), followed by cardiovascular disease, trauma/multiple injury. Conclusion: Analysis of the Eye Bank registers provided valuable information in relation to eye banking and corneal utilisation in Haryana, northern India and significant trends were identified in donor demographics.

Eye Banking: History and Future Direction

Abstract: This chapter explores the history of eye banking, from the first corneal transplant performed by Dr. Eduard Zirm to innovative advancements in the field. The growth of eye banking can be traced to regulations surrounding organ harvesting for transplantation and standardization of eye banking protocols via the Eye Bank Association of America. Additionally, the role of eye banks has evolved significantly through the development of lamellar keratoplasty including DMEK and DSAEK, which has also contributed to the surge in corneal transplantation. In this chapter, we discuss the evolving landscape of eye banking, along with changes in how grafts are prepared for transplantation. This chapter also discusses the future of eye banking, including how new technologies such as engineered grafts and injectable corneal endothelial cells may further change eye banks and their role in processing of tissue for corneal transplantation.

Технология получения ультратонкого заднего послойного трансплантата роговицы в условиях Глазного тканевого банка

Abstract: Objective: to develop technologies for preoperative preparation of the posterior lamellar corneal graft based on our own formulation of the preservation medium for optimal dehydration of the donor cornea and a technique for cutting out an ultrathin flap using an optimized method at the Eye Tissue Bank. Materials methods. In a series of experimental studies, we obtained data on the hydration level of cadaveric donor corneas that were preserved in various solutions at different observation periods. Using 16 corneas, analytical weighing and pachymetry were performed via optical coherence tomography in the experimental (n = 8) and control (n = 8) groups. Morphological and functional characteristics of the corneal endothelium were then assessed. At the next stage of work, ultrathin grafts were formed from 16 corneas after hypothermic preservation in the experimental (n = 8) and control (n = 8) solutions by single-pass microkeratome, followed by microscopy of the samples using a scanning electron microscope. Results. After the first days of preservation in the proposed solution, there was dehydration of 9% cornea in the experimental group in comparison with the samples of the control group. After 4 days of preservation, there was no reliable difference found between the groups (p > 0.05) in the study of the endothelial cell viability of ultra-thin corneal grafts by immunofluorescent microscopy using the «Live and dead» marker. Scanning electron microscopy revealed that corneal stromal collagen fibers, preserved in the proposed medium, retained their integrity. Conclusion. The proposed technology can be recommended for use at eye banks for formation of an ultra-thin corneal graft at the preoperative stage.