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Purpose The purpose of this study was to evaluate agreement between eye banks (EBs) and an image analysis reading center on endothelial cell density (ECD) determinations using the same image analysis method. Methods The Cornea Image Analysis Reading Center (CIARC) determined ECD with a single experienced analyst on EB-obtained central endothelial images from donors intended for keratoplasty from 2 eye banks, Eversight and Lions VisionGift, using the Konan center analysis method. The EBs performed ECD determination on their respective sets of images using the same analysis method with experienced eye bank technicians. Results The mean age of the 200 donors was 54 years (range 30-75 years). Seventy (35%) of the 200 patients were women, and 57 (29%) were diabetic. The mean ECD was 10 cells/mm2 greater by the EBs than by CIARC (P = 0.39), with 95% limits of agreement of [-304 to 323 cells/mm2]. The mean difference was not substantially changed when the difference between EBs and CIARC ECD was adjusted for sex, donor age, donor diabetes, CV, HEX, number of cells analyzed, and EBs as a random effect (estimated mean difference of 20 cells/mm2 after adjustment in a linear mixed model; P = 0.73). The EB-determined preoperative ECD was within 10% of the CIARC-determined ECD for 178 (89%) image sets, with 15 (8%) higher by >10% and 7 (3%) lower by >10%. Conclusions Well-trained eye bank technicians achieve comparable results for ECD determination with an experienced image analyst from an image analysis reading center when the same image analysis method is used.

Purpose The purpose of this study was to evaluate the prevalence of SARS-CoV-2 in human postmortem ocular tissues of asymptomatic donors and its implications on our eye banking protocols. Methods The expression of SARS-CoV-2 RNA was assessed by reverse transcription-polymerase chain reaction in corneal rims and conjunctival tissues from 100 donors who were found suitable for transplantation as per the donor screening guidelines of the Global Alliance of Eye Bank Associations. The donor's clinical history and cause of death were assessed for secondary analysis. Results Of 200 ocular tissues (100 corneal and 100 conjunctival) from the same 1 eye of 100 surgical-intended donors, between September 2020 and April 2021, the overall positivity rate for SARS-CoV-2 was ~1% (2/200). Both the ocular samples that tested positive were conjunctival biopsies (2/100, 2%), whereas corneal samples were negative (0/100, 0%) in both donors. The causes of donor death were trauma in 51 donors, suicide in 33, cardiac arrest in 7, electric shock in 5, metabolic cause in 2, malignancy in 1, and snake bite in 1. None of the donors had a medical history suggestive of COVID infection or possible contact. None of the recipients from the donors were reported to have any systemic adverse event after keratoplasty until the follow-up of 6 weeks. Conclusions The overall prevalence of SARS-CoV-2 was 1% (2% for conjunctival and 0% for corneal samples, P value = 0.5) in the donors who were found suitable for cornea recovery and transplantation. The findings of exceptionally low positive rates in our samples validate the criticality of history-based donor screening and do not support the necessity of postmortem PCR testing as a criterion for procurement and subsequent use for corneal transplantation.

Although an estimated 23% of all global corneal transplants occur because corneal tissue is moved from one nation to another (export and import), the fee structures, fees charged, and use of reimbursement or profit models, to support this practice, have not been evaluated. This article describes the fee structures and determines whether they support or hinder the equitable allocation of corneal tissue. METHODS: We conducted grounded theory semistructured interviews, purposively inviting participants until themed saturation was met. Sentiment analysis was used to determine opinion. RESULTS: We interviewed n = 92 global eye tissue and eye bank professionals. We determined that corneal tissue, which is exported, costs between US $100 and US $6000 or is provided as gratis. Collectively, interviewees indicated that, globally, there were no fixed fee structures in place, and the fee was influenced by multiple factors on both export and import sides. They indicated that ultimately corneas were allocated based on the importers' ability to pay the price determined by the exporting eye bank. DISCUSSION: Allocation of corneal tissue, which is exported, is influenced by the fees charged by the exporters to meet their bottom line and the funds available to importers. Therefore, export allocation is not equitable, with those who can pay a higher fee, prioritized. Steps to guide and support exporters with the development of fee structures that promote equitable allocation are essential. This will assist both export and import eye bank development, corneal tissue access development, and those awaiting a corneal transplant.

Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons. Based on our practical work and literature review, the techniques and postoperative results of the preserved sclera, ear cartilage, and acellular dermal matrix (ADM) as tarsal plate substitutes were investigated. Two cases were reviewed. Case 1 was a 22-year-old female who had total loss of the right lower eyelid. Ear cartilage (23 ​mm ​× ​25 ​mm) was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilage-expander capsule compound structure for lower eyelid reconstruction. Case 2 was a 7-year-old boy with a unilateral divided nevus. The lid and conjunctiva of the lower eyelid were invaded. A piece of ADM (12 ​mm ​× ​4 ​mm) was used to repair the tarsal plate defect (12 ​mm ​× ​3 ​mm). The conjunctiva of ADM was covered by itself. An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction. In case 1, the compound tissue survived and supported the lower eyelid, the lid margin was clear, and the structure was complete over a 1-year follow-up. The aesthetic appearance of the eyelid improved after depilation. It is the first clinical research on the expander capsule as eyelid conjunctiva. In case 2, the conjunctiva completely covered the superior ADM, and the transplant merged with the surrounding tissues without complications after 5 months. The preserved sclera has the longest application history as a tarsal plate substitute. However, it should be preserved in an eye bank and transplanted with conjunctiva repair. Ear cartilage is an autologous tissue that requires conjunctival reconstruction. Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva. It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure. Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility, supportive strength, conjunctivalization, and not requiring donor site surgery. Plastic surgeons are familiar with autologous ear cartilage and ADM, which are easy to obtain and treat. Both ear cartilage and ADM are expected to be the first-line choices in future studies.

Purpose: To determine the postmortem positivity for COVID-19 among voluntary eye donors who had been certified to have died of non-COVID-19 causes. Methods: All donors who donated their corneas (from March 2021 onward) were assessed for COVID-19 positivity tested by nasopharyngeal swab reverse transcription-polymerase chain reaction (RT-PCR) test. Relevant screening history was taken prior to collection. Strict precautions were taken during the retrieval as per the guidelines issued by the National Program for Control of Blindness and Visual Impairment and the Eye Bank Association of India, and the tissues were handled as per standard operating protocol. Results: 85 eye calls were attended during this period, of which 56 were home-based and 29 were from a hospital setting. Samples from 12 of the former group of donors were found to be positive for COVID-19 (14%). Conclusion: This study highlights the possibility of postmortem RT-PCR positivity in voluntary corneal tissue donors without a prior history of symptoms, signs, or diagnosis of illness suggestive of COVID-19. It is recommended that postmortem testing of donors should be done by RT-PCR for retrievals made during the pandemic.

Purpose The purpose of this study was to identify trends in the primary indication for keratoplasty in New Zealand/Aotearoa (NZ) after significant population growth, increase in the number of cataract surgeries per population, widespread adoption of endothelial keratoplasty, and introduction of corneal cross-linking for keratoconus. Methods Statistical analysis of the New Zealand National Eye Bank's prospective database of all keratoplasties was performed between January 1991 and January 2020. Indications for keratoplasty were isolated for the primary diagnosis. Results In total, 6840 corneas were transplanted with mean 236 ± 57.5 transplants/year, increasing from 2.55 to 6.06 per 100,000 NZ population/year. Over the past decade, the number of transplant recipients aged 60 years or older has increased and recipients aged 20 to 39 years have plateaued. In 2019, for the first time, regraft became the most common indication (30.9%), followed by keratoconus (27.9%) and corneal dystrophy (18.8%), with a steady decline in bullous keratopathy. Proportions of the keratoplasty technique changed dramatically: penetrating keratoplasty fell from 91.4% in 2006 to 55.0% in 2019, Descemet's stripping endothelial keratoplasty increased from 0% to 29.5%, anterior lamellar keratoplasty increased from 2.5% to 5.7%, and Descemet membrane endothelial keratoplasty increased from 0% to 9.1%. Conclusions Keratoplasty trends in Aotearoa/NZ have changed considerably because of the evolution of phacoemulsification and keratoplasty techniques. Unlike proportions observed overseas, NZ still performs penetrating keratoplasties in over half of all transplants. Corneal cross-linking may be having an early effect of reducing keratoplasty rates for keratoconus.

Purpose: This review aims to outline current practices and guidelines of corneal donation and eye banking, describes the implications of COVID-19 and emerging diseases on the corneal donor pool, and discusses future trends to improve and increase the efficiency of the processes involved in corneal donation and eye banking. Summary: Corneal screening, preservation, corneal storage, and prevention of systemic disease transmission from donor to recipient have been crucial in shaping the policies of the FDA and eye banks across the world. Eye banks globally have developed varying guidelines and criteria for evaluating the viability of donor corneas. Variables such as the age of the donor, medical history, and potential disease transmission are important screening parameters. While known infectious diseases may be transmissible through the cornea, emerging infectious diseases that are not well studied may be more transmissible than other infections. In particular, coronavirus has impacted corneal transplantation as SARS-CoV-2 expression has been detected in corneal tissue and conjunctiva. In recent years, partial-thickness corneal transplantations have been introduced. Lamellar grafts and other corneal layers are now utilized for transplantation of the specific areas that are damaged.

Sterile donor tomography enables the detection of corneal tissues with refractive anomalies. The aim of this study was to determine the curvature and thickness of donor corneas to support proper selection in the eye bank.704 donor corneas (Klaus Faber Center, LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, in Homburg/Saar) were measured using the anterior segment optical coherence tomograph (AS-OCT) CASIA 2 (Tomey Corp., Nagoya, Japan). The corneoscleral discs were measured in their cell culture flask, which was positioned in a holder on the chin rest of the AS-OCT, after conversion to medium II (with 6% dextran T-500). The measured raw data were analysed and processed in MATLAB (MathWorks Inc., Natick, Massachusetts, USA), after which the refractive power of the steep and flat meridian at the anterior and posterior surface and the central corneal thickness (CCT) of the donor corneas were determined. Results values are expressed as mean x̅ ± standard deviation SD.The mean refractive power of the steep/flat meridian at the anterior surface was 45.4 ± 1.8 D/44.0 ± 1.3 D, the corresponding values for the posterior surface were - 6.2 ± 0.3 D/- 5.9 ± 0.2 D, and the mean CCT was 616.3 ± 85.1 µm. Of the 704 (100%) measured donor tissues, 590 (83.8%)/670 (95.2%) donor corneas showed no anomaly beyond respectively x̅ ± 2 SD/x̅ ± 3 SD among the 5 examined parameters. 72 (10.3%)/23 (3.3%) donor corneas had only 1 anomaly, 26 (3.7%)/10 (1.4%) had 2 anomalies, 10 (1.4%)/1 (0.1%), 3 anomalies, 5 (0.7%)/0 (0.0%), 4 anomalies, and 1 (0.1%)/0 (0.0%), 5 anomalies.AS-OCT provides an objective and sterile screening method to identify corneal tissues with curvature anomalies in order to further optimise donor selection in the eye bank. To avoid postoperative refractive surprises, donor corneas with a total refractive power that deviates ± 3 SD from the mean should not be used for penetrating or anterior lamellar keratoplasty, but may be suitable for posterior lamellar keratoplasty (DMEK or DSAEK). In the future, sterile donor tomography could enable: (1) the harmonisation of donor and recipient tomography, which may minimise residual astigmatism for a particular donor-recipient pair; and (2) the improvement of IOL power calculation in a classical triple procedure by means of regression analysis between pre- and postoperative total refractive power of corneal grafts.Die sterile Spendertomografie ermöglicht die Erkennung von Hornhautgeweben mit refraktiven Anomalien. Ziel dieser Studie war es, die Krümmungs- und Dickenwerte von Spenderhornhäuten zur Selektionsunterstützung in der Hornhautbank zu bestimmen.Vermessungen von 704 Spenderhornhäuten (Klaus-Faber-Zentrum für Hornhauterkrankungen inkl. LIONS Hornhautbank Saar-Lor-Lux, Trier/Westpfalz, in Homburg/Saar) wurden mithilfe des optischen Kohärenztomografen des vorderen Augenabschnittes (VAA-OCT) CASIA 2 (Tomey Corp., Nagoya, Japan) durchgeführt. Messungen der Spenderhornhäute erfolgten durch ihre Zellkulturflasche, die in einer mit 3D-Drucker (Ultimaker 2 Go, Ultimaker B. V., Geldermalsen, Niederlande) hergestellten Halterung auf die Kinnstütze des VAA-OCT positioniert wurde, nach Umstellung des Hornhautgewebes in Medium II (mit 6% Dextran T-500). Die vermessenen Rohdaten wurden in MATLAB (The MathWorks Inc., Natick, Massachusetts, USA) analysiert und verarbeitet, woraufhin die Brechkraft im steilen und flachen Meridian der Vorder- und Rückfläche sowie die zentrale Hornhautdicke der Spenderhornhaut bestimmt wurden. Ergebniswerte werden als Mittelwert x̅ ± Standardabweichung SD angegeben.Die Brechkraft des steilen/flachen Meridians der Vorderfläche betrug 45,4 ± 1,8 dpt/44,0 ± 1,3 dpt, die entsprechenden Werte für die Rückfläche waren − 6,2 ± 0,3 dpt/− 5,9 ± 0,2 dpt. Die mittlere zentrale Hornhautdicke betrug 616,3 ± 85,1 µm. Jenseits x̅ ± 2 SD/x̅ ± 3 SD wiesen von den 704 (100%) gemessenen Spendergeweben 590 (83,8%)/670 (95,2%) Spenderhornhäute unter den 5 untersuchten Parametern keine Anomalie auf. 72 (10,3%)/23 (3,3%) Spenderhornhäute wiesen nur 1 Anomalie, 26 (3,7%)/10 (1,4%) 2 Anomalien, 10 (1,4%)/1 (0,1%) 3 Anomalien, 5 (0,7%)/0 (0,0%) 4 Anomalien und 1 (0,1%)/0 (0,0%) 5 Anomalien auf.Das VAA-OCT bietet eine objektive und sterile Screeningmethode zur Identifikation von Hornhautgewebe mit Krümmungsanomalien, um die Spenderauswahl in der Hornhautbank weiter zu optimieren. Um postoperative refraktive Überraschungen zu vermeiden, sollten Spenderhornhäute mit einer ± 3 SD vom Mittelwert abweichenden Gesamtbrechkraft idealerweise nicht für eine perforierende oder anteriore lamelläre Keratoplastik verwendet werden. Diese Gewebe können jedoch für eine hintere lamelläre Keratoplastik wie die DMEK oder DSAEK geeignet sein. In Zukunft könnte die sterile Spendertomografie Folgendes ermöglichen: (1) die Harmonisierung von Spender- und Empfängertomografie, wodurch der Restastigmatismus für ein bestimmtes Spender-Empfänger-Paar minimiert werden kann; und (2) die Verbesserung der Kunstlinsenberechnung bei klassischer Triple Procedure durch die Regressionsanalyse zwischen prä- und postoperativer Gesamtbrechkraft des Spenderhornhautgewebes.

Supplemental Digital Content is Available in the Text., Purpose: The purpose of this study was to assess the impact of COVID-19 guidelines for corneal donor tissue screening and the utility of routine postmortem COVID-19 testing of donors intended for surgical use at a single eye bank. Methods: A retrospective analysis of referrals to and eligible donors from an eye bank between March 1, 2020, and June 30, 2020, was performed, with the same time period in 2019 as a control. Referrals who were not procured because of Eye Bank Association of America COVID-19 guidelines and eye bank–specific restrictions were noted. The results of 1 month of routine postmortem testing performed by the eye bank were examined. Analysis of variance tests were performed to assess the change between donors from 2019 to 2020. Results: There was a significant reduction in both the number of total referrals to the eye bank (P = 0.044) and donors eligible for surgical transplantation (P = 0.031). Eye Bank Association of America COVID-19 guidelines reduced the number of referrals over this period by 4% to 14%. Of the 266 surgically eligible donors who received postmortem COVID-19 testing in June by the eye bank, 13 resulted positive (4.9%). Conclusions: Despite a reduction in referrals and eligible corneal transplant donors at a single eye bank, there was a surplus of surgically suitable corneal tissue during the first wave of the COVID-19 pandemic. Eye banks should consider routine postmortem COVID-19 testing to identify asymptomatic infected donors although the risk of transmission of COVID-19 from infected donors is unknown.

Introduction Nearly 6.8 million people in India have vision less than 6/60 in at least one eye due to corneal diseases; of these, about a million had bilateral involvement. Purpose To identify the challenges faced; the trends in collection, storage and utilisation of corneal tissues in an eye bank in north India. Materials and methods The past records of Eye Bank linked to a tertiary hospital in northern India were analysed from November’1999 to October’2015 with respect to number of eye donations per year, donor demographics and utilisation of corneal tissues. Results The number of donations during the first 6 years were 100, 279 in the next 5 years and 473 in the last 5 years. The mean donor age was 63.2 ± 19.5 years. The percentage of donors less than 30, 31–60 and more than 60 years was 10%, 28% and 62%. Forty-two percent donations were from the hospital. The average time between the death and enucleation was 4.74 ± 5.31 hours. The percentage of corneas used in the donor age groups less than 30, 31–60 and above 60 years was 61.9%, 61.6% and 53.8%, respectively. The usability rate of the corneas from home and hospital was 63.7% and 55.3%, respectively. Conclusions The eye bank had a lukewarm response in the beginning, but gained momentum with time. The myths and beliefs prevalent in our society deter people from donating eyes freely. Each eye bank needs to individualise its problems and find solutions for adequate procurement and utilisation of tissue.

OBJECTIVES The aim of this study was to evaluate the demographic features of corneal donors and available data of corneas in our eye bank during a 14-year period. MATERIALS AND METHODS The demographic features of the corneal donors, the causes of death, the death-to-excision interval, serology results, the mean endothelial cell density, and the reasons for discarding the corneas were retrospectively evaluated. RESULTS During the study period, 6524 corneas were retrieved from 3326 donors (76.1% male, 23.9% female). Mean donor age was 43.7 ± 16.0 years (range, 4-75 years; median 45.0 years). The most common cause of death was cardiovascular disease (n = 1467; 44.1%). The most common reason for discarding corneas was positive serology (n = 509; 78.6%). The mean endothelial cell density was 3030.1 ± 484.3 cells/mm². There was a weak negative statistically significant correlation between age and endothelial cell density (Pearson correlation coefficient r = -0.187, P < .001). Multiorgan donations made up 1.5% of the whole group (n = 50). CONCLUSIONS We believe that preoperative detailed evaluations of graft quality in addition to review of donor-related medical records and data from previous surgeries, after collecting them in a single system, will have a positive effect on postoperative corneal survival.

The aim of this study was to explore how the implementation of the quality management system (QM; according to DIN EN ISO 9001 : 2008) at the LIONS Eye Bank impacted the rate and reasons for discarding donated corneas. The QM system was introduced in November 2010.The rate of and reasons for discarding cornea tissues at the LIONS Eye Bank Saar-Lor-Lux,Trier/Western Palatinate from 2006 to 2016 were analysed retrospectively. 4,140 corneas from 2,084 donors were analysed. 1,640 corneas were processed before the QM system had been introduced and 2,500 corneas thereafter. Main reasons for discarding cornea tissues were endothelial quality, contamination of the medium and a positive conjunctival swab. The data was extracted from clinical files and data filing systems, entered into a Microsoft Access database and analysed statistically with SPSS.Following the implementation of a QM system, the discard rate decreased significantly from 50.1% to 39.7% (p 0.0001). Prior to the implementation of the QM system, 493 (30.1%) cornea tissues had been discarded due to endothelial quality, while this figure improved significantly to 604 (24.2%) after the QM system had been implemented (p 0.0001). Contamination was the reason for discarding tissue in 173 (10.5%) cases before implementation of the QM system, and in 124 (5.0%) cases thereafter (p 0.0001). Positive conjunctival swab was the reason for discarding tissue in 10 (0.6%) cases before the QM system had been implemented, and in 53 (2.1%) cases thereafter (p 0.0001).Implementation of a QM system significantly reduced the rate of discarded donor tissue in the LIONS Eye Bank. Better management of contamination as a reason for discarding cornea tissues can be attributed to improved standards, protocols and training that are part of this QM system.Ziel dieser Studie war es, den Einfluss der Einführung des QM-Systems (QM: Qualitätsmanagement, nach DIN EN ISO 9001 : 2008) auf die Verwerfungsrate und -gründe von Spendergewebe in einer Hornhautbank zu erforschen. Die Einführung des QM-Systems erfolgte im November 2010.Die Verwerfungsrate und -gründe wurden retrospektiv für die Jahre 2006 bis 2016 in der LIONS-Hornhautbank Saar-Lor-Lux, Trier/Westpfalz des Universitätsklinikums des Saarlandes (UKS) analysiert. 4140 Hornhäute von 2084 Spendern wurden einbezogen. 1640 Hornhäute entstammten der Zeit vor Einführung des zertifizierten QM-Systems (nach DIN EN ISO 9001 : 2008) und 2500 Hornhäute nach Einführung. Bei den analysierten Verwerfungsgründen handelte es sich um die Endothelqualität, Kontamination des Mediums und der positiven Bindehautabstriche. Die Daten der Spender und Hornhäute wurden aus klinikinternen Dokumenten und Systemen in eine Microsoft-Access-Datenbank übertragen und mittels SPSS statistisch ausgewertet.Nach Einführung des QM-Systems sank die Verwerfungsrate von 50,1 auf 39,7% (p 0,0001). Vor der Einführung wurden 493 (30,1%) der Hornhäute aufgrund der Endothelqualität verworfen, nach der Einführung waren es 604 (24,2%) (p 0,0001). Aufgrund einer Kontamination wurden vor Einführung 173 (10,5%) Hornhäute und nach Einführung 124 (5,0%) verworfen (p 0,0001). Wegen des Bindehautabstriches wurden vor Einführung 10 (0,6%) und nach Einführung 53 (2,1%) verworfen (p 0,0001).Die Verwerfungsrate in der LIONS-Hornhautbank konnte nach Einführung des QM-Systems signifikant gesenkt werden. Durch vermehrte Mitarbeiterschulungen sowie durch einheitliche und höhere Standards des QM-Systems bez. Ablauf der Entnahme und Kultivierung konnte die Kontaminationsrate signifikant reduziert werden.

Purpose: To ascertain whether death-to-preservation time (DPT) is associated with donor endothelial cell density (ECD), primary graft failure (PGF), and infection. Methods: Donor corneas aged older than 10 years with ECD 2000 to 4500 cells/mm2 were procured between 2011 and 2018 by a single eye bank. Donor corneas were analyzed retrospectively for the main outcome measures of PGF, infection, and ECD. Means and proportions of study parameters were compared between corneas with long and short DPT, defined as greater or less than 14 hours, respectively, excluding corneas with a history of intraocular surgery or diabetes. Multivariate analyses were performed using logistic regression, adjusting for donor age at time of death, history of diabetes mellitus, and history of cataract surgery. Results: Among 12,015 corneas, those with long DPT had a statistically but not clinically significant higher ECD than that of corneas with short DPT (2754 vs. 2724 cells/mm2, P < 0.01). There was no difference in PGF and infections in corneas with long versus short DPT (0.28% vs. 0.26%, P = 0.86; 0.43% vs. 0.29%, P = 0.51, respectively). Conclusions: Longer DPT is not associated with a clinically meaningful reduction in donor ECD, PGF, or infection.

Purpose: To evaluate the donated cornea and find out the pattern & factors influencing the utilization of corneal tissue. Study design: Retrospective, non-comparative observational study. Material and Methods: Data of 1273 donor eyes collected from all over the 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 cause of death, gender, age, place of tissue procurement, Death to Enucleation time, grades of tissue and various utilization parameters. Results: A total number of 1273 of eyes were procured out of which 774 (60.8%) were fit for corneal transplantation while 499 (39.19%) were not fit. Conclusion: Utility of the donor cornea depends upon various factors like age, death enucleation time, cause of death, maintenance of cold chain and technique of tissue procurement.

Context: There is a global need for quality eye banking practices and sensitization of primary care physicians toward corneal donation. Aims: To evaluate performance of a recently established eye bank (EB) and quality of corneas obtained, and identify areas of improvement during procurement and utilization of donor corneas. Settings and Design: This retrospective observational study is based on records of corneas collected through hospital cornea retrieval programme (HRCP) in the EB of a tertiary care institution during the first 2 years of its establishment. Methods and Material: Data on demographic characteristics of donors, death-preservation interval, specular microscopy parameters of corneas, indications for utilization, and reasons for non-utilization of corneas were collected. Statistical Analysis Used: Means, standard deviation, range, frequencies, and proportions were analyzed. Spearman's correlation coefficient and Kruskal–Wallis test were applied taking P < 0.05 as significant. Results: The EB retrieved 54 corneas from 27 donors with mean age 42.3 ± 24.2 years. All tissues were preserved in Cornisol®. Majority (50%) of transplantable tissues had an endothelial cell density (ECD) between 2,000 and 2,500 cells/mm2. ECD decreased significantly with increasing age (Spearman's ρ -0.747, P < 0.001; Kruskal–Wallis P < 0.001). Overall utilization rate of tissues was 87.04% (47/54), and utilizable corneas (50/54, 92.6%) were mainly used for optical purposes (34/50, 68%). Conclusions: Successful HCRP of the recently established EB has shown considerable promise in terms of quality and utilisation of corneas. There is need for active involvement of primary care physicians in contributing to increasing voluntary eye donation through awareness, advocacy, and social mobilization.

Purpose This study aimed to share our experience in the hospital cornea retrieval program as a new eye bank. Methods This was a retrospective study conducted in a tertiary care institute from August 26, 2019 to March 22, 2020. The medical and eye bank records were analyzed for hospital mortality, mortuary records, and donors approached. The corneal collection was divided between Voluntary (received from voluntary calls), HCRP (cornea received from hospital deaths), and Medico-Legal Cases (received from MLC deaths in hospital) to see the trend of donation and utilization over time. Results During the study period, 154 corneas (77 pairs) were collected. The HCRP provided a major source of corneas 58.4% (90 corneas) as compared to voluntary 19.5% (30 corneas) and MLC 22.1%(34 corneas). There were younger tissues in MLC than HCRP donors, and older tissues in Voluntary donors, and the difference was statistically significant. There was no significant difference in the quality of optical grade tissues and the utilization of corneas for transplants between the three groups. Post hoc analysis showed more non-optical tissues in the voluntary donations (P = 0.004), maximum donors with medical contraindications in the HCRP group (P = 0.001), and time-lapse in corneal retrieval in MLC cases (P = 0.0001). Of these 154 corneas, 78 (50.6%) were assessed as suitable for transplantation, of which 59 (75.6%) tissues were optical grade tissues. The overall utilization was 39.6%. Conclusion HCRP is indeed challenging for a new eye bank, but proper understanding and implementing strategies may help for good utilization of tissues.

PURPOSE: To describe the impact of lockdown and unlock phases of the COVID-19 pandemic on keratoplasty trends at a tertiary eye care center in India. METHODS: This cross-sectional hospital-based study included 6,277 patients presenting between March 25, 2017 and March 31, 2021. The data of the patients who underwent keratoplasty during the lockdown and unlock phases were compared with the respective periods in the previous three years before COVID-19. RESULTS: During the year one of pandemic, there was a 29.46% decline in the total number of keratoplasty performed at the institute compared to previous year's annual numbers. The patients undergoing keratoplasty decreased by 90.28% (28/288) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 40.6% reduction in the proportion of patients requiring interstate travel. There was complete recovery in the number of patients undergoing keratoplasty to 129.27% (184/142) of pre-COVID-19 volumes by March 2021. This gradual incremental trend was seen across all types of keratoplasty in Descemet stripping endothelial keratoplasty (135.29%), penetrating keratoplasty (117.6%), therapeutic keratoplasty (122.22%), anterior lamellar keratoplasty (150%), and Descemet membrane endothelial keratoplasty (141.18%) by March 2021 with the gradual ease of lockdown regulations. The eye bank affiliated to the institute saw a 55.44% decline in donor cornea collection and an increase in utilization rate from 58.12% in previous years to 83.78% in year one of the pandemic. The overall eye bank donor cornea collection recovered to 86.96% (627/721) and tissue utilization increased by 109.99% (455/414) by March 2021. CONCLUSION: The first year of the COVID-19 pandemic saw an overall reduction of 29.46% of the patients undergoing keratoplasty at the institute. There was a gradual and incremental increase in all types of keratoplasty in the unlock phase, which surpassed the preceding years' monthly numbers in February and March.

Introduction: Significant cause of corneal blindness in India is due to trauma and corneal ulcers.India needs 2.5lakh donated corneas every year, the country’s eye banks manage to collect onlyabout 44806, out of these only some are utilized for sight restoration as the others do not meet thestandard for transplantation. The present study aimed to evaluate the awareness regarding eyedonation among the patients and their relatives attending the outpatient department (OPD) at GoaMedical College and hospital, giving them the knowledge and thus encouraging them to pledge theireyes for donation, which is the need of the hour. Material and Methods: This study was conductedon 300 patients who attended ophthalmology OPD (outpatient department) at Goa medical collegeand hospital. This is a closed-end type of study wherein the patients who were willing to participatein the study were requested to fill the form and answer 10 questions related to the awareness of eyedonation and willingness to donate eyes. The questionnaire had the first few questions regardingbrief details about each participant followed by 10 questions which had multiple options andparticipants were requested to answer as per their choice. It was a pretested questionnaire thatincluded questions on eye donation awareness, knowledge regarding the subject, and willingness todonate eyes. All participants were well informed about the study type and written informed consentwas taken for the same. No patients were harmed during the study. Results: The results showedthat 252 (84%)among 300 patients were aware of eye donation. Awareness was maximum throughmass media and hospitals. 68% of responders were not aware that there is an eye bank in Goa.79% of responders were not aware that only cornea is removed from the donor’s eye. Only about32% of the patients were willing to donate their eyes.

Introduction: Visual rehabilitation by corneal transplantation remains the only treatment modality for treatable corneal blindness. Unfortunately the demand of the donated cornea remains high in comparison to its procurement. As these target groups will be future health care providers thus it is important that they know the intricacies of corneal donation. These groups will create awareness among the general public, thereby significantly increasing the corneal donation rate. Objectives: To study the awareness and knowledge among medical, dental and nursing students towards eye donation in a medical college/Tertiary hospital. Materials and Methods: A cross-sectional study was conducted among 100 medical, 100 nursing and 100 dental students studying final year of their respective courses in Chettinad Health and Research Institute, Chennai. Results: There was statistically significance in knowledge between the medical and all other groups showing that medical students are more aware about the practice of corneal donation.(p value: 0.0000001). Overall the awareness about the existence of practice of eye donation was only 57% among the study groups. Only 33.3% of study populations were willing to donate their eyes and 36% of study populations were willing to donate their relative’s eyes. 67.3% of the students required their family‘s consent and approval for corneal donation. 58.6% of the students knew that eyes cannot be donated by a living person and also fact that a living person can only pledge for eye donation. 54 % knew that eyeball should be removed within six hours after death. Only 49% of the study population knew the name of nearest eye bank and only 24.6% of study population knew how long the donated eyes can be stored before transplantation. Overall, the awareness and knowledge of medical students was better than nursing and dental students in all the above aspects (p value: 0.0000001) but the levels of motivation were low in all the study groups (p value

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.

Purpose To determine the changes of corneal thickness and curvature of human corneal grafts in organ culture medium II, containing dextran T500 6%, before keratoplasty. Methods We examined the tomography of 24 corneas from our eye bank transferred from medium I into medium II. Images were repeated hourly during 24 hours using an anterior segment optical coherence tomography. The central corneal thickness (CCT) was measured with the manual measurement tool of the anterior segment optical coherence tomography. The radii of curvature (anterior flat and steep and posterior flat and steep) were measured with a MATLAB self-programmed software for "sterile donor tomography." Results The mean CCT (±SD) at baseline (T0) was 727 ± 156 μm. It reached 581 ± 103, 506 ± 84, 472 ± 79, and 456±7 μm after 6, 12, 18, and 24 hours, respectively. After 12 hours, 83% of the final deswelling was achieved. The radii of curvature (±SD) at baseline (T0) were (posterior flat, posterior steep, anterior flat, and anterior steep) 6.6 ± 0.5, 6.2 ± 0.5, 7.7 ± 0.4, and 7.4 ± 0.4 mm, respectively. After 24 hours, the radii of curvature reached 6.8 ± 0.1, 6.6 ± 0.3, 7.6 ± 0.1, and 7.4 ± 0.2 mm, respectively. Conclusions The kinetics of the deswelling process in medium II follow a hyperbolic curve. Considering a CCT of 506 μm at T12, we assume that a time interval of 12 hours in medium II might be enough for clinical purposes. This result might help to keep storage in medium II as short as possible to escape potential toxic effects of dextran in medium II. The radius of curvature does not seem to change within 24 hours for all measured surfaces.

To evaluate factors affecting corneal endothelial cell density (ECD) under enucleation and preservation time studies at Eye Bank of the Federal District of Brazil. We conducted a case–control study collecting data from 1128 corneas where death-to-enucleation time and enucleation-to-preservation time were within 24 h. Low cell count were those corneas with an ECD less than 2000 cells/mm2 and high cell count was defined as those with ECD greater than 2000 cells/mm2. We calculated the independent risk factors related to: cause of death, donor age, death-to-enucleation time, enucleation-to-preservation time and primary graft failure. Correlation analysis was used to assess which parameters influence ECD: death-to-enucleation time, enucleation-to-preservation time, average cell area (AVE), coefficient of variation and percentage of hexagonal cells. Of the total number of corneas, 1004 had ECD data and were selected for the study. 87.4% (n = 877) had high cell counts with 2699 ± 412 cells/mm2. The mean donor age was 38.8 ± 16 years. The most common causes of death were external causes (48.6%, n = 488). Longer times from death-to-enucleation, up to 24 h were not associated with a decrease in ECD (OR 0.58; P = 0.44) or risk of graft survival (P = 0.74). Enucleation-to-preservation intervals greater than 12 h showed increased risk of graft survival (P = 0.04). AVE was the main parameter for ECD (R2 = 0.96, P

INTRODUCTION: With recent developments in the field of eye banking, human corneas are not only procured and preserved, but also processed and prepared for transplantation. However, one of the challenges that still persists is the long-term storage of tissues without damaging the corneal endothelial cells. Thus, the review aims at reporting the influence of tissue storage conditions on the clinical outcomes. AREAS COVERED: Endothelial cell loss (ECL), graft survival, and contamination from the tissues stored in hypothermic storage and organ culture and; other storage options such as cryopreservation and lyophilization. EXPERT OPINION: Hypothermic storage and organ culture have shown similar ECL. However, due to the relatively new techniques and limited long-term clinical studies, further evaluation is essential to assess the effect of storage time and conditions on the grafts deemed for endothelial keratoplasty.

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.

PURPOSE To report the management of precut Descemet stripping automated endothelial keratoplasty (DSAEK) lenticules unsuitable for transplantation because of irregular anterior profile after microkeratome cutting. METHODS After preparation for DSAEK, 20 tissues were considered unsuitable for transplantation because of nonhomogeneous posterior stromal thickness. To convert them into suitable tissues for surgery, manual stromal delamination was performed by removing the excess stromal layers after the indications obtained through optical coherence tomography. These tissues were further transplanted as ultrathin DSAEK. RESULTS Nineteen tissues were delaminated successfully. The average reduction in thickness in the center (63 ± 69 μm; P = 0.0101) and periphery (129 ± 39 μm; P < 0.0001) before and after delamination was significantly different. One tissue showed signs of perforation during manual dissection and therefore considered unsuitable for transplantation. Primary graft failure was reported in one case, but it was not correlated with the tissue preparation. No other clinical complications were observed after surgery. CONCLUSIONS Manual delamination of the stroma because of irregular microkeratome cutting is a viable option to obtain a uniform graft thickness required for DSAEK surgeries. This technique can further reduce tissue wastage that is observed after microkeratome cutting errors.

Purpose: To evaluate the suitability of corneas from septic donors for transplantation by analyzing the discard rate in the eye bank and the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) using organ-cultured corneal grafts from septic versus nonseptic donors. Methods: This retrospective study included 1554 corneas of which 456 corneas (29%) were from septic and 1072 corneas (69%) from nonseptic donors [for 26 corneas (2%) sepsis status was unknown]. The clinical outcome at 6 months after DMEK was evaluated for 82 grafts (26 from septic and 56 from nonseptic donors). Outcome measures were endothelial cell density, central corneal thickness, and postoperative complications. Results: Primary discard rates were higher for corneas from septic than from nonseptic donors (32.9% vs. 24.5%, P = 0.001). The main discard reason was poor endothelial cell quality for both septic (13.8%) and nonseptic (11.8%) donor corneas. Eye bank contamination rates for septic and nonseptic donor corneas were 1.1% and 1.7%, respectively (P = 0.102). After DMEK, donor endothelial cell density at 6m postoperatively was comparable between grafts from septic and nonseptic donors (1410 +/- 422 cells/mm(2) vs. 1590 +/- 519 cells/mm(2), P = 0.140). No differences in 6m central corneal thickness and in the rebubbling rate were observed between the 2 groups (P = 0.780 and P = 0.396, respectively). None of the cases had graft rejection nor endophthalmitis in both groups. Conclusions: Provided strict adherence to donor screening and evaluation protocols, the use of organ-cultured corneas from septic donors for DMEK does not seem to increase the risk for recipients and allows for expansion of the donor pool for corneal tissue.

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.

Purpose This study aims to investigate possible differences in clinical outcomes between precut and surgeon-cut grafts for Descemet membrane endothelial keratoplasty (DMEK). Methods 142 consecutive patients who underwent DMEK were included in the study. 44 patients received precut tissues, and 98 patients received surgeon-cut tissues. Precut grafts were allocated to the patient by the German Society for Tissue Transplantation if available. We compared the outcomes of both groups for changes in visual acuity, central corneal thickness, endothelial cell density, re-bubbling rate, and graft failure rate. Results Patients who received precut tissues experienced similar increase in visual acuity (median change 0.4 logMAR) and decrease of corneal swelling (median change 132 μm) compared with those who received surgeon-cut tissues (median VA change 0.3 logMAR, p = 0.55, CCT change 118 μm, p = 0.63). There was no statistical difference in endothelial cell density (1436 vs. 1569 cells/mm2, p = 0.37), re-bubbling (32% vs. 35%, p = 0.85), and graft failure rate (5% vs. 1%, p = 0.23). No primary graft failure occurred in the group of precut grafts. Conclusion Both methods lead to comparable results for visual acuity, corneal deswelling, endothelial cell density, and re-bubbling rate. A previously described higher graft failure rate for precut tissues could not be confirmed in our study. Thus, we do not see medical reasons against the use of precut tissues. There are several advantages of precut DMEK tissues over surgeon-cut tissues, especially the prevention of graft loss during preparation in the operating theater.

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.]

Purpose of review Coronavirus disease 2019, caused by novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly infectious; however, the different routes of transmission are not well understood. Transmission through tissue transplantation is possible and must be considered. This review will evaluate the current literature regarding routes of transmission, the likelihood of transmission through ocular tissue transplantation, and the guidelines in place to mitigate this risk. Recent findings Although respiratory droplets have been the primary route of SARS-CoV-2 transmission, there is evidence that transmission through blood donation and organ or tissue transplantation is possible. This includes corneal transplantation, as SARS-CoV-2 has been detected in conjunctival swabs of infected patients, and the ocular surface may play an important role in viral entry. Several tissue transplantation organizations have guidelines in place regarding the screening of donors and tissue procurement procedures, including clinical and/or PCR screening of donors. The Eye Bank Association of America (EBAA) is currently not recommending asymptomatic PCR screening. However, their antiseptic protocols may play an important role in viral inactivation. Summary Based on the current literature and guidelines, the risk of SARS-CoV-2 transmission through corneal transplantation is likely low. However, tissue screening guidelines need to be re-evaluated regularly as knowledge regarding the SARS-CoV-2 virus evolves.

To determine donor cornea contamination rate and to determine factors associated with cornea contamination. To assess the effect of hospitalization, intensive care unit (ICU) time, and antibiotic use on corneal contamination rate. To determine the spectrum of the contaminating microorganisms. The contamination rate of 212 corneas, obtained by enucleation from April 2014 to January 2015 in a single eye bank, was assessed retrospectively according to age, sex, cause of death, systemic antibiotic use, hospitalization time, ICU time, mechanical ventilation (MV), death to enucleation interval (DEI), enucleation to processing interval (EPI), and corneal epithelial exposure grading. The relative risk (RR) and adjusted RR with a 95% confidence interval were calculated using IBM-SPSS 20.0. The contamination rate was 35.6% (n = 75). On multivariate analysis, ICU stay of 4 days or longer and enucleation to processing interval (EPI) greater than 7.4 h (RR 1.58, CI 0.96–2.60, P = 0.06) were associated with donor cornea contamination. Corneal contamination risk was highest from 4 to 6 days at the ICU (RR 3.40, CI 1.54–7.51, P

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.

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.

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.

Purpose: To investigate endothelial keratoplasty lenticules prepared from fresh whole eyes via Gebauer SLc Original (SLc) versus Moria CBm Carriazo-Barraquer (CBm), and those prepared from corneoscleral buttons via SLc versus Moria One-Use Plus (OUP) in terms of eye bank preparation criteria. Methods: Fresh whole eyes-dissected endothelial keratoplasty lenticules with SLc were compared with CBm in terms of thickness profile measurements, over/under dissection values, endothelial cell loss, and postoperative graft failures. A similar comparison was made between corneoscleral buttons-dissected endothelial keratoplasty lenticules with SLc and OUP. Results: Means of central thicknesses and increase of thickness toward periphery were not significantly different between 33 fresh whole eyes-dissected endothelial keratoplasty lenticules with SLc and 33 fresh whole eyes-dissected ones with CBm. There was no significant difference between 19 corneoscleral buttons-dissected endothelial keratoplasty lenticules with SLc and 19 corneoscleral buttons-dissected ones with OUP in terms of mean central thickness and post-cut endothelial cell loss. However, in the corneoscleral buttons-dissected endothelial keratoplasty lenticules, a mean increase of thickness was significantly different from central to two pericentral locations with OUP (P = 0.001) and from central to two peripheral parts with SLc (P = 0.011). Both CBm and OUP systems showed deeper dissection depths than head descriptions as compared to SLc (P < 0.001). Conclusion: Unlike fresh whole eyes-dissected endothelial keratoplasty lenticules with SLc or CBm, thickness profiles of corneoscleral buttons-dissected endothelial keratoplasty lenticules with both SLc and OUP systems showed a partial asymmetric increase of thickness toward the periphery. A high agreement was observed between endothelial keratoplasty lenticules thicknesses and SLc nomograms.

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

To examine the influence on postoperative endothelial cell density (ECD) caused by preoperative temperature change from 4 °C to room temperature in donor corneas for Descemet stripping automated endothelial keratoplasty (DSAEK). This retrospective, case-controlled comparison of 100 eyes that underwent DSAEK using imported donor corneas transferred from an overseas eye bank (SightLife, Seattle, WA, USA). Fifty donor corneas experienced temperature reversal for ECD measurement (TR group), and postoperative outcomes were compared with 50 disease-matched cases that did not experience temperature changes before DSAEK (NTR group). The main outcome measure was endothelial cell loss and reduction rate of ECD at 1, 3, and 6 months following DSAEK. ECD at 3 months following DSAEK was significantly less in the TR group (1458 ± 494/mm2) than in the NTR group (1696 ± 374/mm2; P = 0.014), though ECD at 6 months was not significantly less in the TR group. The reduction rate of ECD at 3 months was greater in the TR group (42.3% ± 17.2%) than in the NTR group (35.7% ± 14.2%; P = 0.044), though reduction rate of ECD at 6 months was not significantly less in the TR group. We found that preoperative temperature change in donor corneas may adversely affect ECD following DSAEK.

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.

To evaluate the reliability and efficiency of sterile pachymetric measurements of donor corneas based on tomographic data using two different methods: a “manual” and a “(semi-)automated” method. Twenty-five (25) donor corneas (50%) stored in MI and 25 (50%) in MII were imaged 5 times consecutively using an anterior segment OCT (AS-OCT). The central corneal thickness (CCT) was measured both with the manual measurement tool of the AS-OCT (= CCTm) and with a MATLAB self-programmed software allowing (semi-)automated analysis (= CCTa). We analyzed the reliability of CCTm and CCTa using Cronbach´s alpha (α) and Wilcoxon signed-Rank Test. Concerning CCTm, 68 measurements (54.4%) in MI and 46 (36.8%) in MII presented distortions in the imaged 3D-volumes and were discarded. Concerning CCTa, 5 (4%) in MI and 1 (0.8%) in MII were not analyzable. The mean (± SD) CCTm was 1129 ± 6.8 in MI and 820 ± 5.1 µm in MII. The mean CCTa was 1149 ± 2.7 and 811 ± 2.4 µm, respectively. Both methods showed a high reliability with a Cronbach´s α for CCTm of 1.0 (MI/MII) and for CCTa of 0.99 (MI) and 1.0 (MII). Nevertheless, the mean SD of the 5 measurements was significantly higher for CCTm compared to CCTa in MI (p = 0.03), but not in MII (p = 0.92). Sterile donor tomography proves to be highly reliable for assessment of CCT with both methods. However, due to frequent distortions regarding the manual method, the (semi-)automated method is more efficient and should be preferred.

The aim of this study was to investigate the tolerability, safety and efficacy of new lyophilized amniotic membrane (LAM) presentation for ocular use. A prospective case-series cohort of four patients with primary nasal pterygium which undergone excision and LAM implantation was evaluated for complications and clinical outcomes. Surgical manipulation of LAM was also assessed. LAM was stiff and easy to manipulate as well as no tearing occurred during surgery or suturing. Ocular comfort was checked and similar among those patients with LAM glued or sutured. After 12 months, there were no issues about tolerability or adverse events. Lower cosmetic outcomes (recurrence) were stated in 3 patients. Our study showed that LAM could be an effective alternative to cryopreserved amniotic membrane for graft after pterygium excision surgery. Its main advantage, storage at room temperature, can make it of immediate availability. Further studies comparing clinical outcomes of pterygium surgery with cryopreserved amniotic membrane versus LAM would confirm the benefits of the last.

Background – Cornea transplantation has an important role in reducing the burden of corneal blindness but availability of corneal donor tissue is a significant limitation. The overall utilization of available cornea is further limited by the quality of donor corneal tissue.Specular microscopic evaluation of donor cornea is emerging as an indispensable tool of endothelial evaluation. Aim – Aim of this study to do an age based specular microscopic evaluation of first 50 corneal tissue obtained through hospital cornea retrieval program at a newly established eye bank in Eastern India Material and method – Total 50 corneo-scleral donor tissue were included in study after excluding the contraindication of cornea donation. Three tissues were could be not included in final assessment due to unavailability of specular microscopic image.47 tissues were divided in different age groups – 60 years (17 tissues). Specular microscopic evaluation was done with Konan eye bank keratoanlyser - CellChek® D® (Konan Medical, Irvine, CA). Endothelial cell density (ECD), corneal thickness (CT), coefficient of variance (CV) and percentage of hexagonal cells (6A) were evaluated and correlated with age. Result – The average age of donor was 47.02 years. The average CT, ECD, CV and 6A were 523.42 +/- 16.37 micron, 2222.87 +/- 514.62 cells/mm2, 35.27 +/- 4.04, 53.06 +/-8.30 % respectively.The difference in ECD was significantly high in age group 60 years in comparison to all other group i.e.

Purpose: To analyze the quality of tissues and outcome of corneal transplants from tissues harvested from the donors of organophosphorus poisoning victims. Methods: A retrospective study was carried out on corneas harvested from organophosphorus poisoning victims between January 2016 and December 2018. Details of quality of tissues and outcome following keratoplasty were collected from the eye bank and outpatient records, respectively. Results: Four hundred and seventy-eight donor corneas were collected from the victims of organophosphorus poisoning during the study period. The mean age of the donor was 38.8 ± 16.5 years. The mean donor-to-preservation time was 6.2 ± 3.2 hours. The mean endothelial cell density on specular microscopy was 2986.5 ± 369.0 cells/mm2. Four hundred and twenty-two (88.2%) donor corneas were utilized. Of the 121 corneas utilized at our institute for transplantation, 73 and 48 corneas were for optical and therapeutic/tectonic indications, respectively. Of the 73 optical grafts, 25 patients were lost-to-follow-up and 58.3% (28/48) who came for one-year follow-up were found to be clear. Conclusion: Donor corneas retrieved from organophosphorus poisoning are safe for transplantation. The postoperative outcome of the tissue utilized from these donors is satisfactory.

Purpose: In India, COVID-19 infected more than 10 million and caused more than 148,000 fatalities during 2020. Due to “lockdown” eye banks were shuttered in March, 2020 and reopened for operations in the month of May, 2020. This study assesses the immediate impact of the pandemic on eye banking and cornea transplantation in India. Methods: Data was gathered through an online survey of the eye banks and cornea surgeons in India. The questionnaire collected information on the vital statistics of eye bank operations and cornea transplants for the period from March to June for the years 2019 and 2020. Results: 47 eye banks responded to the survey. Collectively in the March–May 2020 period, corneas collected and transplanted declined by 78.27% and 79.14%, respectively, compared to the same period of 2019. In June 2020, the first full month after operations restarted, the collection and transplants were respectively, 82.10% and 81.82%, lower than June, 2019. Long-term glycerine preservation of corneas in the period from March to June 2020 increased by 124.5% compared to same period in 2019, but overall only 5.26% of the corneas recovered were preserved in this way. 44.44% of the eye banks collected corneas only from donors with negative COVID-19 diagnosis. 36.11% of the respondents rejected all suspicious cases, such as donors with respiratory pathologies, and 2.78% of the respondents accepted donations from medico legal cases only. 19.44% of the responding eye banks did SARS-CoV-2 nasal swab test for the deceased donor. 79.5% of the eye banks reported that staff were willing to work during the pandemic, and 82.05% eye banks gave special training to staff before restarting services. Conclusion: Due to the steep decline in collections and transplants, 2020 can be termed as a lost year in Indian eye banking. Attention to Hospital Cornea Recovery Programs, continuous situation monitoring, and ongoing staff training programs are recommended.

OBJECTIVES We evaluated 23 years of data for cornea donors at the Istanbul Faculty of Medicine Lions Eye Bank. MATERIALS AND METHODS Annual statistics of corneal donors between 1996 and 2019 were reviewed retrospectively. Records for 2008 and previous years were compared with records for 2009 and years thereafter,to assess donor demographics and reasons for discard of corneas. RESULTS A total of 3849 corneas were obtained from 2018 donors during a 23-year period. Of these, 26 donors (11.2%) were registered, whereas 1792 (88.8%) did not register any decision for donation. There were 210 (5.46%) corneas discarded for positive serology and 291 (7.56%) for unsuitable tissue morphology, and 3348 (86.98%) corneas were determined to be suitable for transplant. For the cause of death in 2009 and subsequent years, the incidence of trauma was lower (P = .001) compared with the years previous to 2009, whereas incidence of cardiac pathology (P = .014) was higher. The number of donors older than 50 years was higher for 2009 and years thereafter, compared with data from earlier years (P = .024). The rate of discarded corneas for unsuitable tissue morphology (P = .004) and total discarded corneas (P = .027) decreased in 2009 and years thereafter. The rate of discarded corneas for HIV was higher after for 2009 and years thereafter (P = .047), whereas the rate of discarded corneas for syphilis was significantly higher for 2015 and years thereafter (P = .001). CONCLUSIONS This study evaluated the most extensive eye bank data in Turkey and found that advances in lamellar surgery techniques and improvements in specular microscopic facilities have expanded the pool for cornealtransplants to include tissues from older donors. Moreover, the incidence rates for HIVpositive and syphilis-positive serology tests in discarded corneas have increased over time.

Purpose Descemet's membrane endothelial keratoplasty (DMEK) is becoming the gold standard to treat corneal endothelial dysfunctions worldwide. Compared with conventional penetrating keratoplasty, infectious complications after DMEK are ill defined. We describe the clinical picture of 2 DMEK recipients, operated on the same day and in the same clinic, who developed atypical herpes simplex virus type 1 (HSV-1) infection in the transplant recipient eye within days post-DMEK. Because recipients received cornea tissue from 2 different donors prepared by the same eye bank, the likelihood of a common HSV-1 source was determined. Design Case series. Participants Two DMEK recipients who developed atypical intraocular HSV-1 disease shortly after surgery and surplus cornea specimens of 6 donors. Methods Surplus cornea donor (pre-DMEK cornea remnants and conditioned cornea storage and transport media) and recipient samples (post-DMEK aqueous humor) were assayed for HSV-1 DNA and infectious virus by real-time polymerase chain reaction (RT-PCR) and cell culture, respectively. Target-enriched whole viral genome sequencing was performed on HSV-1 DNA–positive ocular specimens. Main Outcome Measures Clinical picture of atypical intraocular HSV-1 infection post-DMEK and presence and homology of HSV-1 genomes between ocular specimens of DMEK donors and recipients. Results Herpes simplex virus type 1 DNA was detected in aqueous humor and donor cornea specimens of both DMEK cases, but not in the cornea remnants of 6 randomly selected donors processed by the same eye bank. Infectious HSV-1 was isolated from the cornea remnant and corresponding culture medium of 1 cornea donor. Notably, whole-genome sequencing of virus DNA-positive specimens demonstrated exceptionally high genetic similarity between HSV-1 strains in recipient and donor specimens of both DMEK cases. Conclusions Data indicate cross-contamination of cornea grafts during DMEK preparation with subsequent graft-to-host HSV-1 transmission that caused atypical sight-threatening herpetic eye disease shortly after DMEK. Ophthalmologists should be aware that HSV-1 transmission by DMEK is possible and can lead to atypical ocular disease, a condition that can easily be prevented by taking appropriate technical and clinical measures at both eye bank and surgical levels.

BackgroundSelective lamellar corneal transplantation (keratoplasty) has overtaken full thickness penetrating keratoplasty as the graft choice for endothelial failure. Even more recently eye bank prepared tissues are becoming increasing popular as a way to reduce the risks of tissue loss and stress during endothelial keratoplasty preparation in the surgical theatre. This study compares costs between surgeon and eye bank prepared tissues for Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK).MethodsRetrospective study conducted at the Royal Liverpool University Hospital including endothelial keratoplasties with a minimum of 6 months follow-up time. Cost analysis included surgical expenses, tissue acquisition fees, cost of patient’s ward admission and out-patient expenses, including cost of re-bubbling procedures, costs of visits, anterior segment imaging and optometrist visits within the first 6 months follow-up.ResultsNinety-eight eyes of 98 patients were included in the study of which 42 underwent DSAEK surgery and 56 DMEK surgery. Cost analysis of surgical expenses in the DSAEK group showed a significant difference between using surgeon prepared and eye bank prepared tissue (£3866 ± 296 and £4389 ± 360, respectively;p p ConclusionsAt the Royal Liverpool University Hospital, eye bank prepared tissues had higher surgical expenses compared to those prepared by the surgeon, while the post-operative care expenses were similar between the two groups.

Aim: This study aimed to analyze corneal transplantation trends and voluntary donor characteristics at the Chongqing Eye Bank in China.Methods: We retrospectively reviewed and analyzed data from January 1, 1999, to December 31, 2018, covering 5,397 preregistered voluntary donors, 1,955 actual donors, 3,910 donated tissues, and 2,374 corneal transplantations.Results: The 5,397 preregistered donors included 13 ethnic groups, with an overall mean age of 39.6 years (SD 21.5) and 3,010 were women (55.8%). The most prevalent education level was college and above (2,546, 47.2%), and the most common ethnic group was Han (5,335, 98.85%). Of the 1,955 actual donors, the male-to-female ratio was 3.3, and the mean age was 57.1 (SD 23.0 years). Based on population size in 2018, Jiangbei county was the most active in donation willingness, with ~60 × 10−6 per capita, and the Yuzhong county was the most active in cornea donations, with ~451 × 0−6 per capita. Of the 3,910 donated corneas, 2,540 (65.0%) were clinically used. Of those not used, 978 (71.4%) were rejected for poor corneal quality. The 2,374 (93.5%) corneal transplantation procedures were done at the Department of Ophthalmology of the First Affiliated Hospital of Chongqing Medical University and the rest (n = 166, 6.5%) were performed in other centers. Of those 2,374 corneal transplantations, there were 1,671 penetrating keratoplasty (70.39%), 700 anterior lamellar keratoplasty (29.49%), and three corneal endothelial transplantations in our center (0.13%). The number of annual corneal transplantations increased by nearly 10 times, from 35 cases in 1999 to 327 cases in 2018. Among them, cases of penetrating keratoplasty and anterior lamellar keratoplasty increased from 27, and eight cases in 1999 to 230 and 94 cases in 2018, respectively. Infectious keratitis (37.0%) was the leading indication for keratoplasty, followed by corneal scar (19.8%). Over the study period, corneal scars dropped from the first (41.1% in 1999–2003) to the second indication (20.5% in 2014–2018), while infectious keratitis advanced to take the lead, ranging from 12.2% in 1999–2003 to 26.3% in 2014–2018.Conclusion: Our study reports corneal donation and transplantation trends in Chongqing over 20 years, showing that infectious keratitis is a leading indication for keratoplasty and that penetrating keratoplasty and anterior lamellar keratoplasty show upward trends. The analysis further suggests that a potential preregistered cornea donor is a female Han, with a higher education level.

An eye bank is a unit that administers and handles the requisition and distribution of corneas.The proposed system consists of three parts. The first part consists of temperature and humidity sensors, an array of infrared sensors installed on the shelf of the eye bank, and the eye bank, all of which are interconnected by a Microcontroller. The Wi-Fi module is included in the second section for data transmission to the server, and the third section displays the status of the available eye. The website displays the current status of the eye supply available in the eye bank, allowing eye seekers to obtain cornea from the closest eye bank. iBeacon is an Android app that assists users in finding the best eye donor at the right time.The application stores information about the user, such as name, age, blood type, address, etc.This can ensure the security of the application. The app helps users find the correct eye donor when needed by searching for the eye donor in the correct city/region. This helps reduce the time to manually search for donors.