ABSTRACT
Context: Donor tissue scarcity, Eye Bank Specular Microscopy as yet not made mandatory and tissue utilization often based on clinical judgment only. Aims: Prospectively analyze alteration in clinical grading of donor corneas and hence utilization, based on Eye Bank Specular Microscopy (EBSM) and to infer if EBSM should be mandatory in all eye banks. Materials and Methods: 200 consecutive otherwise ‘suitable for surgery’ donor eyes were graded clinically. On quantitative and qualitative analysis of endothelial cells by EBSM, final grading was adjusted. Impact on subsequent utilization for various surgeries was analyzed with regard to Age of Donor, Death to Enucleation Time, Death to Preservation Time and Lens Status of Donor Eye. Results: 76 eyes (38%) (P < 0.05) had significant change in grading. 12/59 (20.30%) tissues from donors <=40 years showed Cell Density (CD) between 1801‑2500. 19/76 (25%) tissues from donor >60 years showed CD >= 2500. From donor >=81 years, 2/13 (15.3%) eyes showed CD between 2501‑3000 and 1 (7.6%) eye showed CD > 3000. Owing to better grading after EBSM, 13/14 (92.85%) tissues with DTET >6 hours and 5/5 (100%) tissues with DTPT > 16 hours were transplanted. Out of 45 (22.5%) pseudo‑phakic tissues, 21 (46.67%) tissues were used for Therapeutic/Tectonic Penetrating Keratoplasty (PKP) while 24 (53.33%) tissues were used for Optical PKP. Conclusions: EBSM significantly alters final grading of tissues and its subsequent utilization. Acquiring huge importance in areas where adequate supply of corneas is lacking, EBSM becomes an indispensable tool for optimizing availability of qualified tissues for surgery. EBSM should be made a mandatory analysis.
ABSTRACT
PURPOSE: To evaluate corneal endothelial cell changes in Optisol-GS(R) according to enucleation time at different storage temperatures after death. METHODS: Eight rabbit cadavers (16 eyes) were stored at -3 degrees C and room temperature, and enucleation was performed 10 and 24 hours postmortem. The samples were divided into four groups (Group 1 was -3 degrees C, 10 hours, Group 2 was room temperature, 10 hours, Group 3 was -3 degrees C, 24 hours, and Group 4 was room temperature, 24 hours). The corneas were stored in Optisol-GS(R) at 4 degrees C, and we measured corneal endothelial cell density and thickness by specular microscopy on days 1, 3, 5, 7, 10, and 14 of preservation. RESULTS: The densities and thicknesses of corneal endothelial cells of each of the four groups after enucleation showed no significant difference. Corneal endothelial cell density acceptable for penetrating keratoplasty (CD>2500 cells/mm2) was found in groups 1 and 3 until 14 days, in group 2 until 10 days, and in group 4 until 7 days. In particular, eyes stored at -3 degrees C had less corneal endothelial cell loss than at room temperature after 7 days and 14 days (P<0.05). CONCLUSIONS: This study demonstrated that when rabbit cadavers were stored at -3 degrees C, corneas could be preserved in Optisol-GS(R) for 14 days, even if the eyeballs from which they were prepared were extracted within 24 hours postmortem. Within 24 hours postmortem, the storing temperature of the cadavers was found to be more important than the enucleation time for the survival of corneal endothelial cells.