Perception of college-going girls towards corneal donation in North India: A latent class analysis study

Purpose: To assess the perception of college?going girls toward corneal donation in Northern India. Methods: An online survey with a pre?structured, pre?validated questionnaire was conducted on 1721 college?going girls in Northern India. The knowledge and attitude scores were regressed, and latent class analysis was carried out. Results: The average of scores for all participants was computed individually for the knowledge questions and the attitude questions, and based on this score, total participants were divided into two groups: Better corneal donation behaviors (BCDB) and poor corneal donation behaviors. The binomial logistic regression model of knowledge domain for predicting BCDB, age of the participant, their awareness about corneal donation, and willingness to discuss eye donation among family members were found significant. Similarly, for the attitude domain, awareness about corneal donation, knowledge about hours within which ideal eye donation needs to be undertaken, and knowledge about eye donation during coronavirus disease 2019 (COVID?19) pandemic were found to be significant. Latent class analysis identified one subset of participants having poorer knowledge and attitude scores and that they were more from a rural background, were having more than first order as birth order, were belonging to SC/ST classes, had illiterate or secondary education of father and mother, and were living in rented houses. Conclusion: The findings of the study significantly contribute to devising a mechanism to improve knowledge and influencing the attitude about eye donation among the youth, especially young women, who can act as counselors and motivators for the masses as well as their own families, in the generations to come.

Changing pattern of childhood blindness in eight North-Eastern states and review of the epidemiological data of childhood blindness of India

Purpose: To assess the causes of visual impairment and blindness in children in all the schools for the blind in eight northeastern states and to determine its temporal trend, and to analyze the result with reference to various regional epidemiological data on childhood blindness in India. Methods: Children aged ?16 years, with a visual acuity of ?6/18 in the better eye, attending 17 schools for the blind were examined between November 2018 and March 2020. WHO protocol and reporting format was used for the evaluation, diagnosis, and classification of the causes. Results: Out of 465 eligible study participants, 93.76% were blind and only 12.26% of causes were avoidable. Anatomical causes of childhood blindness were whole globe (43.2%), cornea (17.20%), optic nerve (12.04%), retina (9.68%), and lens (9.46%). Etiological causes were unknown (52.69%), hereditary (26.02%), intrauterine (15.05%), and 26.08% had blinding congenital ocular abnormality (s). Regional temporal trend revealed a decrease in corneal and childhood causes and an increase in retina, optic nerve, hereditary, and intrauterine causes. Conclusion: A constellation of causes were differentiable but matched with the overall emerging trend of childhood blindness in India. Higher corneal, unavoidable, and unknown causes suggest a region?specific action plan for controlling childhood blindness as well as rehabilitation

Knowledge, attitude and practice related to eye donation among donor’s and recipients’ family in Ahmedabad: a cross sectional study

Background: India shoulders the largest global burden of blindness. Despite all the advances of science, there is no artificial substitute invented so far to replace human cornea. This study was conducted to assess the knowledge, attitude and practice about eye donation among the eye donors’ and recipient’s family.Methods: A community based cross sectional study was conducted from January 2011 to December 2011 in Ahmedabad city, Gujarat. Eighty-one eye donors and 127 eye recipients using pre-designed and pre-tested proforma was finalized to collect the information from the participants either by home visit (in city) or by telephonic or e-mail interview. Data was entered and analyzed in MS Excel 2007 and Epi info7 software. Knowledge, attitude and practice were expressed as proportions.Results: A total of 81 eye donors and 127 eye recipient’s relatives were interviewed. Doctor or hospital was the most common source of knowledge regarding eye donation for both eye donors (68, 83.95%) and eye recipients (113, 88.97%). In this study 11 (13.58%) eye donors and 4 (3.15%) eye recipients were regular blood donors showing their positive attitude. Only nine (11.11%) donations were done by either donor’s personal will or by already pledging. Among our participants 68 (83.95%) family members had closed the eye lids of the donor after death, 39 (48.15%) had switched off fan of the room after death.Conclusions:Relatives of eye donors and eye recipients are willing to pledge for eye donation after death. Media and medical person was the mainstay in imparting knowledge to the participants. The relative of the donors are well versed with various aspect of preserving eyes after the death of donor compared to those recipients.

Eye donation in north India: Trends, awareness, influences and barriers

Purpose: To understand trends, awareness, influences and barriers to eye donation in Indian society. Methods: This cross sectional study was conducted in Delhi from March 2017 to February 2018. About 10 hospitals collaborated with the Eye Bank under Human Cornea Retrieval Program (HCRP). Eye Bank recruited Eye Donation Counselors (EDCs) to approach family members of the deceased. A pretested questionnaire was used for this study. Irrespective of whether the next of kin of the deceased consented for eye donation or not, the option of participating in the survey was given. Results: Out of 473 potential donors identified, 407 (86%) next of kin consented to participate in the study. Of these, 388 (95.3%) were males and 19 (4.7%) were females. About 168 (41%) consented for eye donation and were assigned to donor group, while 239 (59%) participants refused eye donation and were assigned to non-donor group. Majority of the participants were siblings 170 (41.8%) of the deceased and the mean age of the deceased was 42.71 ± 17.56 years. The foremost concern before decision-making was transparency in how the cornea would be used (32.25%). The concern with regards to whether the body would remain intact after eye donation significantly decreased the probability of consent for eye donation. Conclusion: The study highlights that barriers to eye donation in India are not cultural or religious but more due to misinformation and proper utilization of the donated tissue. This study also emphasizes the pivotal role of EDC's in facilitating the eye donation movement.

Knowledge and attitude regarding eye donation among the people of rural area in Kinaye, Belagavi: a cross sectional study

Background: Corneal diseases are the second major cause of blindness. Corneal transplantation is the most effective treatment with high rate of success but there is a shortage of corneal donors. The study analyzed various factors affecting the willingness to donate cornea. Methods: This community based cross sectional study was conducted among the adults residing in 9 sub-centres under PHC Kinaye, Belagavi in Karnataka, India. The participants (n=400) answered questionnaires which included details such as the demographic profile and, awareness and willingness to donate eyes. Univariate logistic regression analysis was performed for the data. Results: Out of 400 participants, 80.5% were aware of eye donation among which 52% were willing to donate. Univariate analysis showed that adults who were less than 40 years were more aware when compared to those who were more than 40 years (p=0.0001) and more educated adults were willing to donate than illiterate. Adults from joint family were more aware when compared to those from nuclear family (p=0.005). Religious beliefs influenced the willingness of adults for donation as 83.6% denied willingness to donate. Conclusions: The results of our study strongly suggest that there are a lot of misconceptions regarding eye donation in most parts of our country. It is evident from our study that education and involvement of those in health sector, will help to spread knowledge about eye donation and to eliminate misconceptions and ignorance about corneal donation.

Procurement, storage and utilization trends of eye banks in India

Purpose: To study the trends in collection, storage and utilization of donor corneas in eye banks in India. Methods: The data was collected from 12 eye banks in India that collected more than 1000 corneas per year. The retrospective analysis of the parameters like characteristics of the donor and the host, storage media used, number of eyes collected, number of eyes utilized, causes of non-utilization of the tissue and the procedures performed was done. Results: A total of 20,564 eyes were collected by the 12 eye banks during the year 2013–2014. Voluntary eye donation (VED), and hospital cornea retrieval program (HCRP) contributed to 59.6% and 40.4% of tissue procurement respectively. Whole globe enucleation (52.3%) was more commonly performed as compared to in-situ excision of the donor corneas. The most commonly used storage media at all eye banks was McCarey-Kaufman (MK) media (83.3%). The utilization rate of the donor eyes was 50.5%. The most frequent indication for corneal transplantation was infection (active infection - 33.13%, healed infection - 10.78%) followed by Pseudophakic bullous keratopathy (PBK) (13.57%). Full thickness keratoplasty (optical penetrating keratoplasty - 47.23%, therapeutic penetrating keratoplasty - 31.74%) was performed most often followed by endothelial keratoplasty (12.41%) in the developing country. Conclusion: VED still contributes to majority of the donor tissue retrieval in India. The majority of the eye banks still utilize whole globe enucleation technique and store tissues in MK media. Trends from previous years showed a change towards HCRP, in-situ excision technique and preservation in the long-term storage media.

Corneal transplantation in the modern era

Corneal blindness is one of the major causes of reversible blindness, which can be managed with transplantation of a healthy donor cornea. It is the most successful organ transplantation in the human body as cornea is devoid of vasculature, minimizing the risk of graft rejection. The first successful transplant was performed by Zirm, and since then, corneal transplantation has seen significant evolution. It has been possible because of the relentless efforts by researchers and the increase in knowledge about corneal anatomy, improvement in instruments and advancements in technology. Keratoplasty has come a long way since the initial surgeries wherein the whole cornea was replaced to the present day where only the selective diseased layer can be replaced. These newer procedures maintain structural integrity and avoid catastrophic complications associated with open globe surgery. Corneal transplantation procedures are broadly classified as full-thickness penetrating keratoplasty and partial lamellar corneal surgeries which include anterior lamellar keratoplasty [sperficial anterior lamellar keratoplasty (SALK), automated lamellar therapeutic keratoplasty (ALTK) and deep anterior lamellar keratoplasty (DALK)] and posterior lamellar keratoplasty [Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK)] broadly.

Attitude toward eye donation - A population-based study from Western Uttar Pradesh

Background: Corneal blindness is one of the major causes of blindness and vision can be successfully restored by corneal transplantation. Eye donation can improve the availability of cornea, but it depends on awareness and willingness in general population. Objectives: The objectives of this study were to assess the awareness and willingness of urban population of western UP about eye donation and to correlate factors with willingness. Materials and Methods: A cross-sectional study was conducted among randomly selected 400 residents >30 years of age of urban field practice area of the Department of Community Medicine, TMMC and RC, Moradabad. Pre-tested structured questionnaire was used to obtain information about the awareness and perception regarding eye donation. Results: Of 400 participants, 75% were aware about eye donation and 25% were ignorant; print and electronic media were the most common source of information. 51.6 % knew about the time limit of eye donation. 63.5% were willing for eye donation; willingness for eye donation was significantly higher in younger age group, males, and well-educated participants. Conclusion: Our study establishes the need to improve the awareness of eye donation in the study population. The most idealist public health approach would be, to reduce the occurrence of vision loss due to corneal diseases, with effective preventive policies, but as a short-term goal, the key way to deal with corneal blindness is to obtain the required number of corneas for transplantation.

Clinical observation of autologous penetrating keratoplasty in the treatment of corneal blindness / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of autologous penetrating keratoplasty in the treatment of corneal blindness. <p>METHODS: Totally 8 patients with corneal blindness were treated by autologous penetrating keratoplasty in our hospital from 2014-01 to 2018-03. Using retrospective analysis, the patients were followed up for one year. To observe the intraoperative complications and postoperative conditions such as visual acuity, corneal transparency, and other were observed.<p>RESULTS: The uncorrected visual acuity of all the 8 patients was greater than 0.02 1wk after operation, and the rate of restoration of visual acuity was 100%(8/8). The corrected visual acuity of 5 patients(5-8)was more than 0.3 1mo after operation. The corrected visual acuity of 3 patients(3-8)with severe cataract before operation was improved to 0.08-0.2. One year later, all the corneal grafts in the recipient eyes were transparency and no recurrence of infection or secondary infection occurred in all 8 patients. <p>CONCLUSION: Corneal graft is easy to grow and there are no exclusion reactions, fewer postoperative complications after autologous corneal transplantation. So, corneal implants can remain transparent for a long time, and the surgery cost is lower. Autologous corneal transplantation can not only provide long-term useful vision for patients with monocular blindness combined with corneal blindness, but also reduce their financial burden and bring great benefits to patients.

Clinical profile of infective keratitis at tertiary eye care hospital Warangal, Telangana

Introduction: Infective Keratitis is most common cause of corneal blindness in Rural India. Agricultural farmers are more at risk. Fungi and Bacteria are the main cause for this ocular ailment. Early diagnosis and treatment may prevent the corneal blindness. Aim: To evaluate common etiological factors causing Infective Keratitis in the region of Northern Telangana. Materials and Methods: This study was conducted at Tertiary Eye Care Hospital, Regional Eye Hospital, Warangal, Telangana State. Fifty patients were admitted with infective keratitis were clinically evaluated. Each case was analysed and results were recorded as per etiology, clinical symptoms and signs, complications and visual outcome. Results: Age group greater than 40 years (58%) were more common with male predominance (54%) was observed. People living rural area (72%) were affected more than urban areas. Agricultural labour (52%) was mostly seen with infective keratitis. Most of the cases were with trauma (62%) with vegetative matter was mostly seen. Most of the cases were acute (78%) in origin. Fungi were most common organism isolated from the cultures. Staphylococcus and Streptococcus (62%) were common species isolated from bacterial origin and they were antibiotic sensitive (92%). Aspergillous was common fungus isolated Diffuse Corneal ulcer was most common complication. Malnutrition was main cause in systemic illness. Most of the patients before treatment were with no passage of light after treatment visual acuity has prognosis to 6/18 vision. Conclusion: Early diagnosis and treatment may improve the visual prognosis and prevent Corneal blindness due to Infective Keratitis.

A study to assess awareness regarding eye donation among post graduate medical students admitted through NEET pre PG 2014 of Gajra Raja medical college Gwalior, M.P., India.

Background: According to WHO estimates India has 10 million blind populations. Corneal problems cause a significant proportion of blindness in India. Although effective strategies to prevent corneal blindness are likely to be more cost effective, visual rehabilitation by corneal transplantation remains the major treatment for restoring sight in those who already have corneal blindness. The requirement of donor corneas per year is at least 20 times the current procurement. Objective: To assess the knowledge and attitude of post graduate medical students regarding eye donation and their willingness to pledge eyes for donation. Methods: The present study was a cross sectional study conducted using a pretested questionnaire on 116 Post graduate Medical Students but only 106 actually participated in the study. Results: A total of 106 students actually participated in the study. Among them 63 (59.43%) were males and 43 (40.57%) were females. The maximum percentages of the students were of age group 26-29 years. All the students were aware regarding eye donation but still they felt it was necessary to obtain consent from family members. Conclusion: These data showed that although the awareness is good but still there is imperative need to emphasize to evade myths concerning eye donation to promote eye donation.

Donor and tissue profile of a community eye bank in Eastern India.

Purpose: The purpose of this study is to analyze the donor and tissue profile of a community eye bank in Eastern India. Materials and Methods: Eye bank records were analyzed for the period July 2007-June 2011. Variables analyzed included donor demographics (age, gender, and ethnicity), donor cause of death, consent for recovery, death‑to‑preservation interval, preservation‑to‑utilization interval, endothelial cell density (ECD), corneal suitability for transplantation, and corneal tissue utilization. Results: During this study period, 743 corneal tissues were retrieved from 373 donors (male:female = 263:110). The mean age of donors was 52 ± 21 years (range: 3-95 years). The most common donor age group was 41-50 and 71- 80 years. Most of the donors belonged to one religious faith (99%). The most common causes of death were cardiorespiratory failure (34%) followed by road traffic accident (30%). Majority donors were motivated (n = 320; 86%), and remaining (n = 53; 14%) were voluntary. Most of the consents were given by sons or daughters of the deceased (45%) followed by siblings (18%). Mean death‑to‑preservation interval was 3.9 ± 1.9 h. Mean preservation‑to‑utilization interval was 56.0 ± 24.4 h. The mean ECD of donor corneal tissue was 2857 ± 551 cells/mm2 and the median value was 2898 cells/mm2. Of harvested corneas 556 (75%) corneal tissues were utilized. The most common causes of nonutilization were septicemia in donor (n = 56; 30%) and poor quality of tissue (n = 55; 30%). Conclusions: Although, there is significant corneal tissue utilization, there is a need for increased awareness among people in order to augment voluntary donations.

Turning the tide of corneal blindness.

Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world's largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.

Biological Safety Test of Seoultype Keratoprosthesis

PURPOSE: To perform biological safety test of the Seoul-type keratoprosthesis (SKpro) according to the international standards. METHODS: Mouse fibroblasts were used to assess the cellular toxicity, and albino rabbits were used for the irritation test, intradermal test, ocular toxicity test, pyrogenic test and transplantation test. Albino guinea pigs were used for the sensitization test, and rats were used for the acute toxicity test and chronic toxicity test. All tests were performed using the SKpro extracts, which was extracted under 121degrees C for 1 hour using a 0.9% normal saline as the solvent. RESULTS: For the cellular toxicity test, all the rat fibroblasts showed cell proliferation inhibition of less than 29%, which proved to be non-cellular toxic. For the irritation test and the intradermal reaction test, none of the albino rabbits showed skin rash, crust or edema. On the ocular irritation test, there were no conjunctival, corneal or iris abnormalities among the albino rabbits. On the sensitization test, none of the guinea pigs showed skin rash, crust or edema. On the acute systemic toxicity test, there were no signs of lethargy or coma among rats. On the pyrogenic test, no temperature increase was observed in the albino rabbits. On the transplantation test, there was no evidence of graft reaction around the cornea. On the chronic toxicity test, complete blood analysis, urinalysis and histological findings 6 month after exposure showed no signs of abnormalities. CONCLUSIONS: The result of this study shows that SKpro is non-toxic and biologically safe.

Mindoro blindness from corneal degeneration

The Mindoro corneal blindness is a difficult ophthalmological problem in the Philippines. It is degenerative in nature and familial in tendency, with heredity, nutrition and trauma as probable additional factors. There are no evidences to consider it a part of a dermatological, so-called "lapnus syndrome," and there are insufficient findings to incriminate stored rice as the sole cause of it. It is certainly not due to ariboflavinosis. A small, 6.5 mm., central penetrating corneal transplant may remain transparent for many years in the early cases. For moderately advanced cases, it seems to be the first choice, but for the advanced cases, a wide, 9 mm. or more, penetrating keratoplasty, has been followed by opacification of the graft after about a month. A preliminary wide anterior lamellar grafting needs further trial for those advanced casesThe pathologic picture of degenerative keratopathy may be distinct and pure in the beginning but as the lesion advances, those of inflammation, proliferation, death and even necrosis may appear probably because of biological chain reactionsThe pathogenesis of degenerative keratopathies is probably a disturbance or a defect in one or more parts of the metabolic mechanism which interferes with one or more events in metabolismThe etiology of degenerative keratopathies is often multiple and varies with race, heredity, geography, nutrition and other factorsDegenerative keratopathies should be studied along cellular and non-cellular aspects. (Conclusions)