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The cornea transplant is considered the most frequently performed type of transplant in the world, with a demand that has been increasing in recent years. An observational descriptive study was conducted, focusing on the ocular tissue extracted from cadaveric donors from January 2019 to December 2021 at the Red Cross Eye Bank in Medellin, Colombia. This is the first epidemiological characterization of corneal donor tissues within the eye banks of our city, where high rates of violence-related deaths explain that tissue donors are mostly young individuals. This, in turn, results in excellent counts of endothelial cells and tissue viability in their microscopic studies. Additionally, there are lower rates of discarded tissues compared to similar studies. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to evaluate the profile of the cases of conjuntivitis treated in the emergency department of the Banco de Olhos Hospital, emphasizing the infectious conjunctivitis, and compare before and after the onset of the Coronavirus pandemic and social isolation, both in public and private health care system. Methods: A retrospective and transversal study where electronic files of the patients who visited the emergency department between March and June of 2019 and 2020 were reviewed. Results: A significant reduction in the number of consultations at the emergency department was observed after the beginning of the pandemic. From March to June 2019, 21.678 visits were made. In the same period of 2020, this number was 14.194, a drop of 34.5%. The rate of visits having conjunctivitis as main cause also dropped significantly. Infectious conjunctivitis was the one who showed the highest decrease. In 2019, it was responsible for 30.2% of the visits and, in 2020, for 15.5%. There were no changes regarding the gender, but a significantly increase in patients’ age was observed. Conclusion: The study showed a dramatic reduction in the number of visits at the emergency department of ophthalmology regarding infectious conjunctivitis after the beginning of the pandemic, and we believe that the cause is related with an increase of hygiene care, social isolation and restrictions caused by the Coronavirus pandemic. [ABSTRACT FROM AUTHOR]

Introduction: The cure of corneal blindness requires manifold increase in the rate of eye donation. The present study was undertaken to assess the knowledge and attitude about eye donation among medical students. A secondary objective of the study was to assess the impact of knowledge of eye donation after studying ophthalmology among the final year students of the MBBS (Bachelor of Medicine Bachelor of Surgery) graduation course. Aim: To assess knowledge and attitude about eye donation among first, second and final year medical students. Also, to assess the impact of studying 'Ophthalmology' on their knowledge. Materials and Methods: A cross-sectional study was conducted by collecting information on a predesigned, structured questionnaire on 'Google forms' and sending a soft copy to 601 students of two medical colleges i.e, GGS Medical College, Faridkot and Dayanand Medical College, Ludhiana, Punjab, India, by email, from March 2019 to April 2019. There were questions about awareness and source of information about eye donation in medical students, knowledge of criteria, and willingness to donate eyes. Responses were accepted till a period of seven days. Students were divided into two groups; group A (n=320 students) with 165 students in first professional year and 155 in second professional year, who had not studied Ophthalmology. Group B (n=281 students) with 142 students in final (part I) professional year and 155 in final (part II) professional year, who had/were studying Ophthalmology. Results were analysed and compared using Chi-square test. Results: Out of 601 students, 527 responded (272 of group A and 255 of group B). The results on knowledge and willingness to donate eyes were quite encouraging. Most of the questions were answered by more than 400 students. Majority of students cited teachers/friends as their source of knowledge. However, there was a saw significant gaps in knowledge in the students, specially before reading Ophthalmology (p-value<0.05). Conclusion: More efforts in the form of counselling techniques, short trainings, videos, need to be put into medical curriculum, ophthalmology teaching and short in-job trainings to make the MBBS students an important link in increasing cornea retrieval. [ABSTRACT FROM AUTHOR]

Introduction: The cure of corneal blindness requires manifold increase in the rate of eye donation. The present study was undertaken to assess the knowledge and attitude about eye donation among medical students. A secondary objective of the study was to assess the impact of knowledge of eye donation after studying ophthalmology among the final year students of the MBBS (Bachelor of Medicine Bachelor of Surgery) graduation course. Aim: To assess knowledge and attitude about eye donation among first, second and final year medical students. Also, to assess the impact of studying ‘Ophthalmology’ on their knowledge. Materials and Methods: A cross-sectional study was conducted by collecting information on a predesigned, structured questionnaire on ‘Google forms’ and sending a soft copy to 601 students of two medical colleges i.e, GGS Medical College, Faridkot and Dayanand Medical College, Ludhiana, Punjab, India, by email, from March 2019 to April 2019. There were questions about awareness and source of information about eye donation in medical students, knowledge of criteria, and willingness to donate eyes. Responses were accepted till a period of seven days. Students were divided into two groups; group A (n=320 students) with 165 students in first professional year and 155 in second professional year, who had not studied Ophthalmology. Group B (n=281 students) with 142 students in final (part I) professional year and 155 in final (part II) professional year, who had/were studying Ophthalmology. Results were analysed and compared using Chi-square test. Results: Out of 601 students, 527 responded (272 of group A and 255 of group B). The results on knowledge and willingness to donate eyes were quite encouraging. Most of the questions were answered by more than 400 students. Majority of students cited teachers/friends as their source of knowledge. However, there was a saw significant gaps in knowledge in the students, specially before reading Ophthalmology (p-value

Purpose: The Hospital Corneal Retrieval Program (HCRP) aims to counsel and encourage the family of a critically ill or deceased person in the hospital for eye donation. Adequately sensitized health-care workers (HCWs) may play a pivotal role in boosting HCRP., Study Design: Multicentric, cross-sectional, descriptive study., Methods: Study participants included all HCWs of three medical colleges, including one with eye bank and corneal transplant services. A pretested, structured questionnaire was used to record the awareness, knowledge, and attitude about eye donation among HCWs. The expected outcome was to seek differences in awareness, if any, among medical and paramedical workers of medical colleges with (group A) or without (group B) eye bank and corneal transplant facilities., Results: Of the 4060 study participants, 2100 HCWs were in group A and the rest (1960) were in group B. For eight out of 13 questions assessing awareness and perception, a statistically insignificant difference in responses was observed between the two groups. Regarding questions related to attitude, although the majority of HCWs in both groups were comfortable talking about eye donation, they did feel that counseling relatives of a terminally ill patient about eye donation was insensitive. Less than half of HCWs showed a willingness to donate eyes, and about half of the participants wanted to acquire more knowledge about eye donation., Conclusion: Awareness regarding eye donation among HCWs was mostly found to be at dismal levels, irrespective of whether they worked in an institute with or without eye bank and corneal transplant services. This warrants an accelerated effort at sensitizing HCWs as a strengthening measure for HCRP., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To determine endothelial cell density (ECD) from real-world donor cornea endothelial cell (EC) images using a self-supervised deep learning segmentation model., Methods: Two eye banks (Eversight, VisionGift) provided 15,138 single, unique EC images from 8169 donors along with their demographics, tissue characteristics, and ECD. This dataset was utilized for self-supervised training and deep learning inference. The Cornea Image Analysis Reading Center (CIARC) provided a second dataset of 174 donor EC images based on image and tissue quality. These images were used to train a supervised deep learning cell border segmentation model. Evaluation between manual and automated determination of ECD was restricted to the 1939 test EC images with at least 100 cells counted by both methods., Results: The ECD measurements from both methods were in excellent agreement with rc of 0.77 (95% confidence interval [CI], 0.75-0.79; P < 0.001) and bias of 123 cells/mm2 (95% CI, 114-131; P < 0.001); 81% of the automated ECD values were within 10% of the manual ECD values. When the analysis was further restricted to the cropped image, the rc was 0.88 (95% CI, 0.87-0.89; P < 0.001), bias was 46 cells/mm2 (95% CI, 39-53; P < 0.001), and 93% of the automated ECD values were within 10% of the manual ECD values., Conclusions: Deep learning analysis provides accurate ECDs of donor images, potentially reducing analysis time and training requirements., Translational Relevance: The approach of this study, a robust methodology for automatically evaluating donor cornea EC images, could expand the quantitative determination of endothelial health beyond ECD.

Purpose: To assess the feasibility of theranostics to determine the riboflavin concentration in the cornea using clinically available ophthalmic formulations during epithelium-off (epi-off) and transepithelial (epi-on) corneal cross-linking procedures., Methods: Thirty-two eye bank human donor corneas were equally randomized in eight groups; groups 1 to 3 and groups 4 to 8 underwent epi-off and epi-on delivery of riboflavin respectively. Riboflavin ophthalmic solutions were applied onto the cornea according to the manufacturers' instructions. The amount of riboflavin into the cornea was estimated, at preset time intervals during imbibition time, using theranostic UV-A device (C4V CHROMO4VIS, Regensight srl, Italy) and expressed as riboflavin score (d.u.). Measurements of corneal riboflavin concentration (expressed as µg/cm 3 ) were also performed by spectroscopy absorbance technique (AvaLight-DH-S-BAL, Avantes) for external validation of theranostic measurements., Results: At the end of imbibition time in epi-off delivery protocols, the average riboflavin score ranged from 0.77 ± 0.38 (the average corneal riboflavin concentration was 213 ± 190 µg/cm 3 ) to 1.79 ± 0.07 (554 ± 103 µg/cm 3 ). In epi-on delivery protocols, the average riboflavin score ranged from 0.17 ± 0.01 to 0.67 ± 0.19 (corneal riboflavin concentration ranged from 6 ± 5 µg/cm 3 to 122 ± 39 µg/cm 3 ) at the end of imbibition time. A statistically significant linear correlation (P ≤ 0.05) was found between the theranostic and spectrophotometry measurements in all groups., Conclusions: Real-time theranostic imaging provided an accurate strategy for assessing permeation of riboflavin into the human cornea during the imbibition phase of corneal cross-linking, regardless of delivery protocol. A large variability in corneal riboflavin concentration exists between clinically available ophthalmic formulations both in epi-off and epi-on delivery protocols., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Heather Machin,1,2 Brian Philippy,3 Graeme A Pollock1,2 1Lions Eye Donation Service, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; 2Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia; 3Distribution Department, Lions Medical Eye Bank and Research Center of East Virginia, Norfolk, VA, USACorrespondence: Heather Machin Email heather.machin@unimelb.edu.auAim: The exportation of corneas from one nation to another, for transplantation services, is responsible for 23% of all global transplants. Global allocation is possible because of the end-of-life donations from citizens and residents of export nations. To date, there is no information indicating if export nation donors are aware that their corneas may be exported, nor if organizations that export provide information regarding their export engagement to their community. To ascertain if and how exporters inform their community, we audited known export organization public websites.Materials and Methods: We designed and conducted a double-blind audit of known exporting eye banks, eye tissue sharing and distributor organization websites.Results: We audited 79 websites, from 9 nations. Of the 79, 46 (58.2%) did not mention corneal tissue exportation, 17 (21.5%) implied exportation, and 16 (10.2%) explicitly mentioned it. Of the 16 that mentioned they exported, 75% (12/16) provided information regarding their export license, and 12.5% (2/16) indicated partnership with a third party. We could not locate information explaining how organizations decided on how and to whom they export.Discussion: Organizations that export corneal tissue across national borders do not share sufficient information regarding their export activities on their website. The general public and donors within export nations may not be aware that this practice occurs or could occur with their donation. Export organizations and the eye tissue sector must evaluate their communication strategies and collaborate, preferably nationally, to develop publicly appropriate information regarding corneal tissue exportation.Keywords: corneal tissue, distributors and brokers, export, eye banks, transparency, website

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

PurposeTo describe the indications, visual acuity outcomes, and graft survival after penetrating keratoplasty (PKP) in Addis Ababa, Ethiopia.MethodsThe medical records of patients who underwent PKP at Menelik II Hospital between September 2000 and September 2013 were retrospectively reviewed. The prespecified outcomes were graft survival, visual acuity, and complication rates.ResultsA total of 321 patients underwent PKP during the study period and were included in the analysis. Indications for surgery were trachoma or leukoma in 141 (44%), keratoconus in 45 (14%), corneal dystrophy in 46 (14%), pseudophakic or aphakic bullous keratopathy in 28 (9%), trauma in 27 (8%), previous graft failure in 18 (6%), active ulcer, burn, or perforation in 9 (3%), and others in 7 (2%). The graft survival rate was 80% overall at 2 years but varied considerably depending on the indication for surgery. Uncorrected visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.09 (SD 0.67) to mean logarithm of the minimum angle of resolution of 1.53 (SD 1.03) at 2 years. A number of factors affected the visual acuity outcomes. Patients were not routinely refracted, and only 18% (N = 60) of patients had access to corrective spectacles or contact lenses postoperatively. Complication rates were high with infectious keratitis being the most common.ConclusionsPKP is becoming a viable treatment for corneal opacity in developing countries. However, the high burden of disease and lack of corrective lenses remain significant obstacles to overcome.

Copyright of Türkiye Klinikleri Journal of Ophthalmology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Successful corneal transplantation relies on the viability of the corneal endothelium. Although various preservation systems have been developed in the field of eye banking, long-term storage of the corneal endothelium poses challenges and is costly. Optisol-GS in the past has been the most commonly used solution for intermediate-term corneal storage in the United States. However, disruptions in the availability of Optisol-GS, caused by rising costs and supply shortages, have necessitated alternative methods of corneal preservation. Previously described preservation methods include hypothermia (2-8°C) for short-term storage (7-14 days), organ culture (28-37°C) for intermediate storage (4-7 weeks), and cryopreservation for longer-term storage. In this review, we examine standard practice and alternative methods for corneal storage., Competing Interests: A. L. Sabater: Ocubio, Tissuecor, Abbvie, Brill Pharma, GSK. J. Cipolla and M. Jo have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The cornea is an avascular and transparent layer of connective tissue crucial to retinal image quality. Diseases can impair its quality, affecting vision. Keratoplasty is the only therapy capable of restoring vision quality in severe corneal involvement. Despite the established practice of transplantation, access to corneal tissue is limited in many places, and the quality of retrieved corneas is not always adequate, resulting in disqualification. Not all factors affecting tissue quality are fully understood due to the multifactorial nature of processes and variations in procedures globally., Objective: The objective is to map the global literature to establish the factors associated with the clinical and sociodemographic conditions of donors, and the conditions inherent in the processing of corneas that can influence the quality of this tissue for transplantation purposes., Methods and Analysis: A scoping review will be developed based on the methodological framework of the Joanna Briggs Institute. The scientific report will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension checklist for Scoping Reviews. Searches will be conducted in 30 indexed and 12 grey literature databases, without time or location restrictions. The selection of studies will be carried out in three distinct phases: screening, eligibility and inclusion. After defining the sample, data from the selected studies will be systematically extracted into an electronic spreadsheet. The results will be presented descriptively through tables and graphs of absolute and relative frequency. In addition, the PRISMA Scoping Review flow chart will be presented to present the process of searching, including and excluding articles and documents., Ethics and Dissemination: This scoping review study does not require prior ethical approval as it uses publicly available and already published studies. The research protocol is registered in the Open Science Framework (osf.io/bw6r7). The findings will be submitted for publication in peer-reviewed scientific journals and presented at ophthalmology and/or transplantation conferences through oral presentations or posters., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To report the outcomes of standardizing pre-loaded DMEK with endothelium-inwards and its associated learning curve., Methods: Between 2017 and 2021, a total of 599 tissues were stripped using 'trephine and strip' method and loaded by folding the tissue as a taco-fold with endothelium-inwards. The folded tissues were pulled inside the funnel of a 2.2 mm IOL cartridge and stored for the desired number of days in organ culture media supplemented with dextran. Donor characteristics, endothelial cell loss (ECL) and mortality assessed by trypan blue positivity before and after stripping, and eventful cases during stripping/loading were recorded., Results: The tissues found unsuitable for transplant after stripping (6.7%) were significantly higher compared with loading (0.67%). Central or peripheral tears, fragility of the tissues, and insufficient endothelial cell density mainly attributed towards the discard rate. Mean ECL from pre-stripping to post-stripping was 0.27% with endothelial cell mortality of 0.64% at the end of stripping. Cumulative endothelial mortality fold change (pre-strip to post-strip) was high in the first two years of operation (18.9%), which reduced to 5.1% in the following three years with significant difference (p = 0.0352). Average tissue wastage (3 operators) from first 1-150 tissues was 3%, which significantly reduced to 0.9% after achieving the learning curve (151-250) (p = 0.0492)., Conclusion: DMEK graft preparation requires a learning curve. However, an operator with DMEK stripping skills can easily adapt to pre-loading a DMEK graft in endothelium-inwards fashion with minimal learning curve., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This review highlights the evolution in the scope of eye banking activities in India. The roles and responsibilities of the eye banks have expanded to match the requirements and necessities that arose because of advancements in keratoplasty techniques and the need for corneal surgeons. Adoption of different types of corneal preservation solutions and methods of donor cornea preservation was a consequence of the changing and unprecedented times. The growth of eye banking in India has been a commendable journey and has placed the country in an "almost sufficient" category in eye banking and corneal transplantation. There exists a potential to reach the status of cornea surplus country in the future. The rules and laws governing eye banking operations need dynamic amendments based on the trends in keratoplasty, surgical practice patterns, and status of self-sufficiency. Newer technological advances and quality measures must be adopted in donor cornea evaluation and tissue preparation. Research should be integrated as an important component of eye banking, especially in developing novel methods of donor preservation, and evaluating and validating the existing and changing practices of eye banking., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: Human ocular tissue banking plays an important part in the advancement of translational research for identifying the molecular processes involved in disease etiology and pathogenesis. Timely obtaining a good-quality ocular tissue from a cadaveric donor is exceedingly difficult, especially in remote areas, with a variable transportation time (within 12-24 h), raising concerns about RNA quality and its subsequent applications. Therefore, we assessed the utility of retinal tissues from cadaver donor and enucleated eyes based on the RNA quality and gene expression by real-time polymerase chain reaction (PCR)., Settings and Design: Prospective study., Methods: Retina tissues were separated from the donor/enucleated eyes received in the eye bank within 24 h of death (n = 15) and within an hour from OR (n = 3), respectively, and stored immediately at -80 degree. RNA was isolated using trizol, and the quantity and quality were assessed using Qubit and agarose gel electrophoresis, respectively. QPCR was performed for measuring the expression of different retinal-specific genes. The cellular viability of the retina was assessed by establishing explant primary cell cultures., Statistical Analysis: The data were calculated as an average of normalised Ct values ± standard error of the mean., Results: RNA obtained from cadaveric tissues despite being partially degraded showed a uniform strong gene expression of several retinal-specific genes such as PAX6, RHO, TUBB3, CRX , and ALDH1L1 . The primary cultures established from cadaveric tissues showed viable cells., Conclusion: The cadaver donor tissues collected within 24 hours of death can be effectively utilized for gene expression profiling., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: In Germany, approximately one-third of the harvested donor corneas are not suitable for transplantation, mostly due to insufficient endothelial cell density (ECD). The ECD can only be reliably determined after harvesting and processing of the cornea. Our group has previously developed a predictive model for corneal ECD: \( {Predicted\, ECD} = 2919-6^{\ast}\;{age}\; [{years}]-189\; [{if\, male}]\\ -7^{\ast}\;{death-to-explantation\, interval\,} [{hours}]\\ - 378\; [{if\, pseudophakic}] \;{cells/mm}^2 \)., Methods: A total of 2.999 consecutive donor corneas harvested between 2017 and 2021 from the Eye Bank of Rhineland-Palatinate in Mainz, Germany, were included. An actual ECD of >2000 cells/mm2 was defined as the cutoff value. To evaluate the clinical utility of the prognostic model as a screening instrument for transplant eligibility in an independent cohort, we performed a decision curve analysis., Results: The median predicted ECD was 2061 cells/mm2 (interquartile range [IQR] = 1834 to 2221), whereas the median actual ECD was 2377 cells/mm2 (IQR = 1907 to 2624). There was a positive correlation between predicted and actual ECD (correlation coefficient = 0.411; P < 0.01). Our predictive model for ECD is a strong predictor for an actual ECD greater than 2000 (odds ratio = 1.374, 95% confidence interval [CI]) per 100 cells; P < 0.001, area under the curve [AUC] of 0.73). Decision curve analysis showed that the predictive model yielded a positive net benefit in clinical settings., Conclusions: Decision curve analysis demonstrated a positive net benefit of the ECD predictive model in clinical settings with limited eye bank resources., Translational Relevance: In possible scenarios where a choice between corneal grafts is required, or in countries with limited eye bank infrastructure and staff, the initial estimate of ECD from the formula may be beneficial.

Objective: This study aimed to evaluate the long-term graft survivability of locally prestripped versus imported prestripped Descemet membrane endothelial keratoplasty (DMEK) grafts in Edmonton., Design: Prospective cohort study of patients who underwent DMEK surgery between January 1, 2020, and December 31, 2020., Participants: All patients receiving a DMEK transplant during the study period in Edmonton., Methods: Two local technicians were trained to prestrip DMEK grafts in Edmonton. When available, local tissue was prestripped for DMEK surgery; otherwise, prestripped DMEK grafts were imported from an accredited American eye bank. Patient characteristics and DMEK graft characteristics and DMEK survivability were evaluated and compared between the 2 groups., Results: Thirty-two locally prestripped DMEK grafts and 35 imported prestripped DMEK grafts were used during the study period. Donor cornea characteristics and patient characteristics were similar between the 2 groups. Best-corrected visual acuity improved up to 6 months postoperatively and was 0.2 logMAR in the locally prestripped DMEK group and 0.2 logMAR in the imported DMEK group (p = 0.56). Rebubble rates were 25% in the locally prestripped DMEK group and 19% in the imported DMEK group (p = 0.43). There was 1 primary graft failure in each group (p = 0.93). Endothelial cell density decreased by 37% in the locally prestripped DMEK group and by 33% in the imported DMEK group 2 years after transplantation., Conclusions: The long-term survivability of locally prepared DMEK grafts is comparable with that of DMEK grafts imported from American eye banks., (Copyright © 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate Descemet membrane endothelial keratoplasty (DMEK) scroll width and length in relation to variable velocities as the tissue transits through wide and narrow lumen glass tubes., Methods: Sets of DMEK tissue were processed using the Iowa Lions Eye Bank standard DMEK protocol and were passed through 2 glass tube widths at variable speeds. Two hourglass-shaped glass tubes were created, one "wide" and one "narrow." A syringe pump, valve, and pressure gauge were used to modulate tissue speed through each tube. For both tube sizes, DMEK tissue was passed through their lumens with incrementally increasing velocity and visualized with a high-speed camera at frame rates from 1000 to 8000 fps. Scroll width and length were measured using IDT Motion Studio software and digital calipers., Results: There was a significant, indirect correlation between scroll velocity and width in both the wide (R 2 = -0.98, P < 0.001) and narrow (R 2 = -0.84, P < 0.001) tubes. There was a significant, direct correlation between scroll velocity and length in both the wide (R 2 = 0.84, P < 0.001) and narrow (R 2 = 0.83, P < 0.001) tubes. The resting widths of the scrolls were 105% and 207% wider than the wide and narrow tubes, respectively. All transits recorded scroll widths that were equal to or smaller than their respective tube's internal diameter., Conclusions: There is a significant, inverse correlation between DMEK scroll velocity and width as well as a direct correlation between scroll velocity and length, allowing DMEK scrolls to transit through a tube that is narrower than its resting width without sustained lumen wall contact., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

ObjectiveTo examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP).DesignMulticenter, prospective, double-masked clinical trial.ParticipantsWe included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥ 10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema).MethodsCorneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD).Main outcome measuresEndothelial cell density at 10 years.ResultsAmong study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm(2) (interquartile range [IQR], 522-850 cells/mm(2)), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm(2) (IQR, 483-694 cells/mm(2); P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P1000 cells/mm(2).ConclusionsSubstantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years.

ObjectiveTo determine whether the 10-year success rate of penetrating keratoplasty for corneal endothelial disorders is associated with donor age.DesignMulticenter, prospective, double-masked clinical trial.ParticipantsA total of 1090 participants undergoing penetrating keratoplasty at 80 sites for Fuchs' dystrophy (62%), pseudophakic/aphakic corneal edema (34%), or another corneal endothelial disorder (4%) and followed for up to 12 years.MethodsForty-three eye banks provided corneas from donors aged 12 to 75 years, using a randomized approach to assign donor corneas to study participants without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines.Main outcome measuresGraft failure defined as a regraft or, in the absence of a regraft, a cloudy cornea that was sufficiently opaque to compromise vision for 3 consecutive months.ResultsIn the primary analysis, the 10-year success rate was 77% for 707 corneas from donors aged 12 to 65 years compared with 71% for 383 donors aged 66 to 75 years (difference, +6%; 95% confidence interval, -1 to +12; P = 0.11). When analyzed as a continuous variable, higher donor age was associated with lower graft success beyond the first 5 years (P

Purpose: To evaluate reproducibility of endothelial cell density (ECD) measurements using the Konan Cell Check D in donor corneas by two different ophthalmologists and to compare the two automated cell count methods (center and flex-center) available in the software of this specular microscope., Methods: ECD values were quantified in 54 donor corneas by two independent investigators using the Cell Check D (Konan Medical USA Inc) with both automated cell count methods. In the center method, at least 30 contiguous cells are marked. For the flex-center method, an area is delineated and only the cells within the designated area are counted., Results: The mean ECD was 2473.81±378.22 cells/mm 2 . Good ECD intergrader reproducibility for the center (ICC=0.821) and the flex-center method (ICC=0.784) were noted. Poor reliability was observed for coefficient of variation and hexagonality (ICC≤0.265). When both methods for ECD analysis were compared, a moderate correlation for the two independent graders using the two manual (center and flex-center) methods was detected (correlation coefficient of 0.678 and 0.745 for each of the investigators). Comparison between methods yielded significantly higher ECD with the flex-center method (P=0.013). When corneas were divided by ECD, those under 2200 cells/mm 2 and those between 2200 and 2700 cells/mm 2 also had significantly higher ECD with the flex-center method (P<0.022)., Conclusions: ECD values are reproducible with both methods, although the flex-center method ECDs tend to be higher, particularly in cases of low ECD. Eye banks and surgeons should exercise caution in making decisions based only on small differences in ECD., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

There are various surgical methods for corneal transplantation, each requiring precise treatment tailored to the characteristics and different layers of corneal opacity or lesions. These layers include the corneal epithelium, stroma (lamellar), and corneal endothelium, with options for full-thickness (penetrating) corneal transplantation or artificial corneal transplantation. However, a current issue in clinical practice is that, regardless of the degree of corneal disease, the availability of corresponding eye bank support, or surgical conditions, classic penetrating (full-thickness) corneal transplantation is universally performed. Alternatively, there is a trend toward adopting technically demanding procedures such as endothelial transplantation and artificial corneal transplantation. This trend has led to increased postoperative complications and the wastage of corneal donor materials. Choosing the appropriate corneal transplant procedure can offer advantages such as preserving more healthy corneal tissue, conserving corneal donors, facilitating rapid vision recovery, and minimizing the risk of immune rejection. Corneologists need to master the indications for various corneal transplant surgeries and systematically perform different corneal transplant procedures based on the surgeon's skills, hospital conditions, and eye bank conditions. This approach aims to enhance the success rate of the surgery.

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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the Descemet membrane endothelial keratoplasty (DMEK) preparation performance of trainee surgeons in an ex vivo human donor cornea DMEK wet lab simulation setting., Methods: Human donor corneoscleral rims unsuitable for transplantation were obtained from Moorfields Lions Eye Bank. At the wet lab, graft stripping was performed by scoring the peripheral endothelium. The trypan blue positive cells (TBPC) and cell density (cells/mm 2 -reticule count) were counted manually before and after stripping. The procedural time, peripheral and central tears and complete peel-off were also recorded and analysed., Results: Eight trainee surgeons attended the wet lab each attempting three DMEKs. Between the first and last attempts a significant decrease was seen in the procedural time (17.6 min vs 10.6 min (p<0.05)) and the TBPC % (12.9% vs 3.8% (p<0.05)). The percentage of tears peripherally and centrally also reduced between the first and the last trials (50% vs 13% (p=0.2226) and 38% vs 0% (p=0.1327)). A significant correlation was found between longer peeling times and higher TBPC % (p<0.001) with a 0.7% endothelial mortality increase for each additional minute required to complete the peel., Conclusions: DMEK wet labs provide a controlled risk-free learning opportunity for trainee surgeons to improve confidence and competence. Wet labs improve the success rate of DMEK graft preparation as well as flatten the learning curve. This emphasises the importance of continued support for the expansion of this valuable learning resource, promoting wider uptake of DMEK surgery., Competing Interests: Competing interests: VR and SA are the editors of the journal., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Purpose: The aim of this study was to report trends in keratoplasty techniques and indications in the United States from 2015 to 2020., Methods: This retrospective review of annual reports from the Eye Bank Association of America assessed domestic corneal graft distribution and surgical indication data for various types of keratoplasty. Trends in procedure volume and indications from 2015 to 2020 were analyzed using the Cochran-Armitage test., Results: The total number of corneal transplants increased from 47,903 in 2015 to 49,143 in 2019, with a decline to 42,257 in 2020, most likely due to COVID-19. Penetrating keratoplasty (PK) volume decreased from 2015 to 2020 (19,160-15,402, 40% to 36.4%, P < 0.001), continuing a trend from the previous decade. Descemet membrane endothelial keratoplasty as a percentage of all keratoplasty procedures increased (9.8%-27.8%, P < 0.001), whereas Descemet stripping automated endothelial keratoplasty (47%-33.9%, P < 0.001) and anterior lamellar keratoplasty (ALK) decreased (2.3%-1.2%, P < 0.001).From 2017 to 2020, repeat corneal transplant was the most common specific indication for PK while ectasias/thinnings decreased in prevalence (15.6%-11.5%, P < 0.001). Ectasias/thinnings and endothelial dystrophy remained the leading indications for ALK and endothelial keratoplasty, respectively., Conclusions: From 2015 to 2020, keratoplasty trends in the United States showed a continuation of the decrease in PK and increase in Descemet membrane endothelial keratoplasty observed in the previous decade. The most common domestic indications from 2017 to 2020 have been repeat corneal graft, endothelial dystrophy, and ectasias/thinnings for PK, EK, and ALK, respectively., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

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Currently, there are no specific guidelines in place to direct eye banks on how to deal with donated tissue from transgender individuals. This commentary will examine the history of corneal transplantation and the importance of the corneal tissue donor. In doing so, the donor selection criteria established by the Food and Drug Administration will be presented. Additionally, the history of blood donor deferral policies created for men who have sex with men and how those policies have changed over time will be explored. We provide an evidence-based framework for potential guidelines regarding the transgender population and eye tissue donation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the effect of head trauma-related deaths on corneal endothelial cell density (ECD) in eye bank donors., Methods: This is a retrospective study of 287 corneas from donors with causes of death secondary to motor vehicle accident with sustained head trauma (n = 50), gunshot wound to the head (n = 138), fall with sustained head trauma (n = 2), and non-head-related traumatic causes of death (n = 97). Donors older than age 50 years were excluded due to concern for undiagnosed Fuchs endothelial dystrophy as a potential confounder for the cause of endothelial cell loss. Donor characteristics, ECD, and focal endothelial cell loss on specular microscopy were compared between the groups. Donors in the head trauma and nonhead trauma groups were matched by age; there were 42 age-matched donors in both groups., Results: Age and ECD were negatively correlated (Pearson correlation coefficient = -0.57). Death-to-preservation time was not significantly different between the 2 groups ( P value = 0.59). The mean ECD in the head trauma group was 2859 ± 370 cells/mm 2 and 3041 ± 464 cells/mm 2 in the nonhead trauma group. The head trauma group had a lower ECD (178 ± 70 cells/mm 2 , P value = 0.013). After matching for age, the difference in ECD between the 2 groups was -94 ± 82 cells/mm 2 ( P value = 0.26). The adjusted odds of having focal endothelial cell loss was not statistically significant ( P value = 0.50) between the groups., Conclusions: After statistical adjustments, there were no differences between the head trauma and nonhead trauma groups., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: None

Corneal blindness ranks third among the causes of blindness worldwide, after cataract and glaucoma. Corneal transplantation offers us a means to address this, and is currently the most commonly performed transplantation procedure worldwide - restoring the gift of sight to many an eye. Eye banks play a very important role in these procedures. India was quick to develop its own eye bank in 1945 soon after the launch of world's first eye bank in 1944. The evolution over the past six decades has been tremendous, placing India on the top, with one of the largest eye-banking system in the world. As of 2023, around 740 members are registered under the Eye Bank Association of India. The highest-ever collection of 71,700 donor eyes was achieved in 2017-2018. The overall tissue utilisation rate ranged between 22 - 28 % for voluntary donations and 50% for hospital-based corneal retrieval programs. Though India has an excellent infrastructure and readiness for corneal transplantation surgery, the need of the hour is to create a strong and independent nodal system. It shall take care of the logistics and factor in technological advances - surgical and otherwise. Public awareness, a national corneal grid, and reducing the red-tape barriers, shall improve availability of grafts nationwide. This review aims to detail the evolution of eye banking in India, to provide a comprehensive understanding, and help the stakeholders focus on the road ahead to attain our targets faster., Competing Interests: None

This case series highlights the challenges in eye banking and the importance of a quality assurance program. Three cases triggered corrective and preventive actions (CAPAs) to improve the processes. Case 1 emphasized training to prevent retrieval failures. Case 2 stressed the need for blood samples and comprehensive documentation. In Case 3, mishandling led to policy revisions and staff training. CAPA involved identifying concerns, root cause analysis, action plans, implementation, checks, and closure. Errors can occur in man, machinery, process, and policies. Continuous CAPA ensures continuous quality improvement and safe corneal tissue transplantation, benefiting patients in need., Competing Interests: None

Corneal blindness (CB) is one of the leading causes of blindness in India and globally, affecting around 8 million population worldwide. Many of these corneal blind patients may be visually rehabilitated by corneal transplantation (CT). Eye banking plays a crucial role in facilitating CT and ocular research. Many countries have adopted regulatory frameworks, quality assurance programs, and technological advancements to enhance the efficacy and safety of CT. Various infrastructural and organizational frameworks of eye banks (EBs) in India, according to the Eye Bank Association of India (EBAI), aid in establishing guidelines and standards for EB practices. Initiatives such as the National Programme for Control of Blindness (NPCB) have significantly contributed to eye donation rates and improved access to donor corneas. This review article discusses the established eye banking networks in countries such as India, the United States (USA), and Europe, where dedicated EB organizations work collaboratively to ensure efficient procurement, processing, and distribution of corneal tissue. It also highlights specific strategies employed in India and global countries to address EBs' challenges. These challenges include the shortage of donor corneas, improving donor screening and tissue processing techniques, ensuring timely distribution of corneal tissue, and maintaining high-quality standards. Interestingly, the comparative analysis between India and other developed countries highlights the similarities and differences in eye banking strategies. By understanding the strategies employed by different regions, EBs can learn from each other's experiences and work toward achieving optimal outcomes in CT and ocular research worldwide. It underscores the importance of knowledge sharing and collaborative efforts in addressing common challenges and implementing best practices in eye banking., Competing Interests: None