9†Supply of non-clinical ocular tissue from a tissue and eye services research tissue bank.

INTRODUCTION: NHS Blood and Transplant Tissue and Eye Services (TES) is a human multi-tissue, tissue bank supplying tissue for transplant to surgeons throughout the UK. In addition, TES provides a service to scientists, clinicians and tissue bankers by providing a range of non-clinical tissue for research, training and education purposes. A large proportion of the non-clinical tissues supplied is ocular tissue ranging from whole eyes, to corneas, conjunctiva, lens and posterior segments remaining after the cornea is excised. The TES Research Tissue Bank (RTB) is based within the TES Tissue Bank in Speke, Liverpool and is staffed by two full-time staff. Non-clinical tissue is retrieved by Tissue and Organ Donation teams across United Kingdom. The RTB works very closely with two eye banks within TES, the David Lucas Eye Bank in Liverpool and the Filton Eye Bank in Bristol. Non-clinical ocular tissues are primarily consented by TES National Referral Centre Nurses. METHODS AND RESULTS: The RTB receives tissue via two pathways. The first pathway is tissue specifically consented and retrieved for non-clinical use and the second pathway is tissue that becomes available when tissue is found to be unsuitable for clinical use. The majority of the tissue that the RTB receives from the eye banks comes via the second pathway. In 2021, the RTB issued more than 1000 samples of non-clinical ocular tissue. The majority of the tissue, ~64% was issued for research purposes (including research into glaucoma, COVID-19, paediatrics and transplant research), ~31% was issued for clinical training purposes (DMEK and DSAEK preparation, especially after COVID-19 cessation of transplant operations, training for new eye bank staff) and ~5% was issued for in-house and validation purposes. One of the findings was that corneas are still suitable for training purposes up to 6-months after removal from the eye.In 2021, the RTB received 43 applications for ocular projects from new customers and supplied to 36 different projects, meeting 95% of all orders placed this year. DISCUSSION: The RTB works to a partial cost-recovery system and in 2021 became self-sufficient. The supply of non-clinical tissue is crucial for advancement in patient care and has contributed to several peer-reviewed publications.

Eye banking and keratoplasty trend analysis during the COVID-19 pandemic: A South Indian observational study.

Purpose: To analyze the impact on eye donation and corneal transplantation during the COVID-19 pandemic in a tertiary eye hospital in south India. Methods: A retrospective analysis of the donor and recipient records during the study period from January 2020 to May 2021 was conducted and tabulated in Microsoft Excel 2013. Demographic details of the donor, utility rate, cause of death, culture characteristics, storage methods, wet lab usage, and the surgical donor outcomes were evaluated. Additionally, the postoperative workup of the recipients, diagnosis, graft infection and rejection episodes, development of COVID-19 postoperatively, and outcome in terms of visual acuity at one, three, and six months were also noted. Results: A total of 466 eyes from 249 donors were received during the study period. The mean age of the donor population was 62.43 years (20.9). The corneal transplantation utility rate was 36.4% (n = 170). Fifty-one percent of the total transplant surgeries were for therapeutic purposes. This was followed by penetrating optical keratoplasty (34%), Descemet's stripping endothelial keratoplasty (9%), and patch grafts (3%). Seventeen (10%) graft rejection episodes were noted and nine (53%) had complete resolution after medical treatment. Conclusion: Proper preventive measures are key to carrying out safe and efficient eye banking activities even during a deadly pandemic, as COVID-19 transmission via transplantation is rare.

20†Factors influencing the discard of clinical tissue and NHSBT methods to maintain a low discard rate.

INTRODUCTION: NHS Blood and Transplant Tissue and Eye Services (TES) is a human multi-tissue, tissue bank supplying tissue for transplant to surgeons throughout the UK. NHSBT has two Eye Banks. These are NHSBT Filton, based in Bristol and NHSBT David Lucas Eye Bank, which is based in Speke Liverpool. MATERIALS AND METHODS: NHSBT monitors our monthly discard rates with the aim to review for any patterns. Due to the NHSBT Eye Banks using a computer system called PULSE we can categorise all our discard for further analysis. Focusing on key areas such as Contamination, Corneal Assessment failure such as Low Endothelial Cell count, Medical deferrals and blood sample quality. RESULTS: 2019- NHSBT Procured 5705 Eyes and Issued 4725. This is a discard rate of 19%2020- NHSBT Procured 3725 Eyes and Issued 2676. This is a discard rate of 28%2021- NHSBT Procured 4394 Eyes and Issued 3555. This is a discard rate of 19%Based on the EEBA Statistical report of Eye Banking Activity in Europe for 2019- 42663 Eyes/Corneas in situ were procured and 25254 Corneas supplied for transplant. This is a discard rate of 41%.Based on the EEBA Statistical report of Eye Banking Activity in for 2020- 33460 Eyes/Corneas in situ were procured and 21212 Corneas supplied for transplant. This is a discard rate of 37%. DISCUSSION: Based on this data, NHSBT discard rate is below the European Average. Key factors which contribute to this low discard rate. Independent Clean rooms for excision and assessment operating to a Grade A Level. A centralised National Referral Centre and 4 dedicated Retrieval Teams ensure retrievals are within 24 hours of Death, and excision occur within 24 hours of enucleation. A dedicated Admin and Clinical Nursing Team performing the medical release ensures the Tissue is released promptly after Microbiological Testing (Day 10) for Assessment. During 2020 due to COVID all routine operations were cancelled suddenly. This resulted in an Increase of discard due to time expiry. REFERENCES: EEBA Statistical report of Eye Banking Activity in Europe for 2019 and 2020.

4†New strategies in the barcelona eye bank to minimize the impact of the COVID-19 pandemic.

Since the start of the pandemic, the tissue donation in Catalonia (Spain) has decreased drastically. At the beginning of the lockdown (from March to May 2020) there was a drop of around 70% in donation of corneas and of approximately 90% in donation of placentas. Despite the fast updating of standard operating procedures, we had big difficulties in different points. For instance, in the availability of the transplant coordinator for the donor detection and evaluation, in obtaining the necessary PPE (personal protective equipment), or in the resources available in the quality control laboratories for screening. This, added to the collapse that hospitals suffered due to the large number of patients hospitalized each day, made donation levels slowly rebound.In order to provide solutions to all patients, we tried to adapt quickly to these emerging changes.In the case of corneas, we found a scenario that we had never had before. Although the cornea transplant plummeted at the beginning of the confinement (decreased by 60% compared to 2019), we run out of corneas -even for emergency situations- at the end of March.This situation led us to develop a new type of therapeutic solution in our Eye Bank. The cryopreserved cornea for tectonic purposes is a tissue that is kept frozen at -196°C and can be preserved for up to 5 years. Therefore, it is a tissue that allows us to respond to possible emergencies in subsequent similar situations.Regarding amniotic membrane for ocular care indications, the strategy was completely different. For this kind of tissue, we carried out an adaptation of our processing with two different purposes. On the one hand, to make sure that we could inactivate the SARS-CoV-2 virus, if it was there. On the other hand, to increase the donation of placentas. For this, changes in the transport medium and in the antibiotic cocktail were performed. In addition, an irradiation step was added to the final product.Little by little, it seems that the donations of corneas and placentas have been recovering. However, it is necessary to think about future contingency strategies in case a stop in donation is repeated.

34†Decreased opportunities to approach next of kin for eye donation to the liverpool research eye bank due to COVID-19.

BACKGROUND: The Liverpool Research Eye Bank (LREB) specialises in collection and storage of ocular tissues for use in projects investigating ophthalmic diseases and potential treatments. In collaboration with the Liverpool Eye Donation Centre (LEDC), we collect whole eyes from cadaveric donors. The LEDC screens potential donors and approaches next-of-kin for consent on behalf of the LREB; however, there are factors which reduce the pool of donors such as transplant suitability, time constraints, medical contraindications and other complications. During the past 21 months, COVID-19 has been a big contraindication to donation. The study aimed to determine how much of an impact COVID-19 has had on donations to the LREB. METHODS: Between January 2020 and October 2021, the LEDC compiled a database detailing the results of decedent screen at The Royal Liverpool University Hospital Trust site. From these data the suitability of each decedent for transplant, research or unsuitable for both was extrapolated along with the number of decedents unsuitable specifically due to having COVID-19 at the time of death. Data on the number of families then approached regarding donation for research, the number who gave consent and the number of tissues collected were also included. RESULTS: The LREB did not collect any tissues from decedents who had COVID-19 listed on their death certificate during 2020 and 2021. The number of unsuitable donors for transplant or research increased considerably due to COVID-19 positivity, in particular, during the months of Oct 2020-Feb 2021. This led to decreased approaches being made to next of kin. Interestingly, COVID-19 did not appear to have directly affected the number of donations. The number of donors consented ranged from 0-4 per month throughout the 21 months, with no correlation to the months when COVID-19 deaths were at their highest. CONCLUSIONS: The lack of an association between COVID-19 cases on donor numbers suggests that the donation rates are influenced by other factors. Increasing awareness of the opportunity for donation for research may increase donation rates. Development of informational materials and organisation of outreach events will aid in this goal.

8†The donor of tomorrow: challenges posed by the pandemic, demographic change, and increased transplant requirements.

In the Corona pandemic, the importance of donor health for the supply of patients with high-quality transplants has once again become particularly apparent in the field of cornea donation.And there are further challenges ahead: Due to new operation methods such as lamellar techniques an earlier stage of disease can be treated hence patients are being operated at younger ages. At the same time, with demographic change, potential donors are getting older.Therefore, the demand for a high-quality transplant without pre-operations seems to be difficult to fulfil in the future. This is particularly important in the highly developed industrialised countries, where the indications for corneal transplantation are different and the expected quality characteristics are therefore other than in emerging or developing countries, for example. At the same time, the new surgical methods present the tissue banks with new tasks to meet the surgeons' demands.In the DGFG network, the average age of corneal donors is currently 69.7 years while the requests for transplants with a high endothelial cell density (ECD) increase. The ECD continues to be one of the main criteria for a high-quality cornea and is more likely to be found in younger donors. As mentioned at the beginning, however, the average life expectancy in Germany is already currently around 80 years.It seems that it is impossible to find the perfect donor of tomorrow. With the increase in the need for high-quality transplants, the question must be asked whether donor shortage is a home-grown problem in industrialised countries. What developments need to be initiated to counter the trend towards donor shortage? Could greater flexibility at the medical and/or regulatory level be a solution? The presentation aims to shed light on these and other questions and would like to discuss this with the experts.

Impact of the COVID-19 pandemic on the trends in corneal donor mortality data from Eye Bank records in India.

Purpose: To describe the causes and trends of corneal donor mortality from eye bank data in India during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This retrospective eye bank-based study included 13,529 donors who donated their cornea between January 2018 and December 2021. Donors in whom the cause of mortality was documented were included as cases. The data were collected from the eye bank records. Results: Overall, 13,529 corneal donors were included in the study. Most of the donors were males (69.71%). The mean age of the donors was 51.55 ± 20.54 years, whereas the median age was 51 (inter-quartile range: 35-68) years. The mean age of males (49.3 ± 19.47 years) was lesser than the mean age of females (56.72 ± 21.94 years) at the time of donation. The most common age group at the time of donation was during the sixth decade of life with 2,139 (15.81%) donors. The mean age of the donors decreased by a decade from 54.95 ± 20.51 years in 2018 to 44.35 ± 18.88 years in 2021. The most common cause of donor mortality was cardio-respiratory arrest in 5,190 (38.36%) donors and trauma in 3,469 (25.64%) donors, followed by suicide in 2,790 (20.62%) donors. The trend of cardio-respiratory arrest decreased from 53.01% to 9.5% (p = <0.00001), whereas the trends of trauma increased from 21.93% to 36% (p = <0.00001) and suicide increased from 12.71% to 36.41% (p = <0.00001) between 2018 and 2021. Conclusion: Corneal donors are more commonly males in their sixth decade of life. The most common cause of donor mortality was related to cardio-respiratory arrest with a concerning rising trend in suicide cases over the years seen significantly during the pandemic.

Impacts of COVID-19 pandemic and public policies on corneal transplantations in Brazil.

PURPOSE: The study aimed to evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic and public policies on corneal donations and transplantations in Brazil and get reliable indicators to support effective measures for improving the system of obtaining, processing, distributing, using, and controlling donated ocular tissues. METHODS: A questionnaire was applied by the Brazilian office of the Pan-American Association of Eye Banks (APABO) to Brazilian Eye Banks to collect data from January to August 2020 and generate reliable indicators about the impact of the COVID-19 pandemic on corneal donations and transplantations in Brazil. RESULTS: Data from 37 Eye Banks showed that 76.1% of the 3,060 donations and 74.5% of the 3,167 transplants occurred in the pre-pandemic period. From the 6,052 processed corneas, 71.8% were provided for therapeutic purposes: 72.9% were transplanted, 26.1% ended up being discarded (45% of which qualified for optical transplantation), and 1% remained in stock in glycerin. Of the 1,706 corneas that could not be eligible for therapeutic use, 47.9% were excluded due to tissue conditions, 43.6% for serological reasons, 6.7% due to contraindications found in clinical history after retrieval, and 1.8% for other factors. CONCLUSIONS: The negative impact of the COVID-19 pandemic on corneal donations and transplantations in Brazil resulted from the recommendation of the Health Ministry to suspend the retrieval of ocular tissues from donors in cardiopulmonary arrest for almost six months. The indicators reveal the compelling requirement for updating both the classification and cornea provision criteria by the Eye Banks and improving the Brazilian corneal distribution system.

The Effect of COVID-19 on Corneal Donor Volumes and Eye Bank Processes: An Analysis From the Eye Bank of Canada (Ontario Division).

PURPOSE: With the rise in COVID-19 cases, the Eye Bank of Canada (Ontario Division), the largest eye bank in Canada, was faced with challenges related to ocular donor suitability which resulted in tissue shortages after the first wave of COVID-19 cases in Ontario, Canada. This article aims to analyze the impact of COVID-19 on ocular tissue donation and transplant surgeries. METHODS: Trends in ocular donations in 2020 and the transplant rates were compared with the data from the previous year, as a benchmark of normal eye bank activity. RESULTS: Ocular donor volumes decreased during the first wave of the COVID-19 pandemic (March-June 2020) by 65% as compared to the same period in 2019. By the end of the year 2020, this had resulted in a total reduction of 29% of ocular donor volumes as compared to 2019. The ocular transplant surgery volumes in the year 2020 decreased by 32% compared to the previous year, mostly secondary to elective surgery shutdown during the first wave. Because of tissue shortages, the Eye Bank of Canada (Ontario Division) had to import 24 corneas from the United States and cancel 7 surgeries in the year 2020. CONCLUSIONS: The decline in ocular tissue donor volumes and transplant surgery was a result of an interplay of causes related to the COVID-19 pandemic. Most importantly, ruling out of COVID-19 carriers, lockdown measures affecting tissue retrieval processes, and shutdown of elective surgery were the 3 major factors accounting for tissue shortages and surgical volume reductions.

Risk and Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Infection on Corneal Transplantation: A Case-Control Study.

PURPOSE: The purpose of this study was to evaluate the risk of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after corneal transplantation surgery, with cataract surgeries as controls, and the impact of the novel coronavirus disease pandemic in the clinical and surgical complications of corneal transplantation and cataract surgeries. METHODS: A retrospective matched case-control study of 480 consecutive individuals who underwent surgery at the Bascom Palmer Eye Institute between May 2020 and November 2020. A total of 240 patients who underwent corneal transplantation with tissue obtained from the Florida Lions Eye Bank were age, race, ethnicity, and sex matched with 240 patients who underwent cataract surgery during the same day and by the same surgical team. Only the first corneal transplant or cataract surgery during this period was considered for each individual. All donors and recipients were deemed SARS-CoV-2 negative by a nasopharyngeal polymerase chain reaction test before surgery. Postoperative SARS-CoV-2 infections were defined as previously SARS-CoV-2(-) individuals who developed symptoms or had a positive SARS-CoV-2 polymerase chain reaction test during the first postoperative month. RESULTS: Mean age, sex, race, and ethnicity were similar between groups. There were no differences between the corneal transplant and cataract groups in the rates of SARS-CoV-2 infection before (5.8% vs. 7.5%, P= 0.6) or after surgery (2.9% vs. 2.9%, P = 1). The rates of postoperative complications did not increase during the pandemic, compared with previously reported ranges. CONCLUSIONS: In this study, postoperative SARS-CoV-2 infection was similar for individuals undergoing corneal transplantation or cataract surgery. Further research is required to evaluate the transmission of SARS-CoV-2 through corneal tissue.

Clinical Utility of COVID-19 Real Time-Polymerase Chain Reaction Testing of Ocular Tissues of Non-COVID-19 Cornea Donors Deemed Suitable for Corneal Retrieval and Transplantation.

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.

Immediate impact of COVID-19 on eye banking in India.

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.

COVID-19 positivity rate in corneal tissue donors - A cause for concern!

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.

Impact of COVID-19 Pandemic on Infectious Keratitis Outcomes: A Retrospective Multicenter Study in Tertiary Eye Hospitals of South India.

PURPOSE: The purpose of this study was to report the adverse effects of the COVID-19 pandemic on the clinical outcomes of infectious keratitis in South India. METHODS: Two hundred fifty-eight patients presented with infectious keratitis at 6 tertiary care centers when strict travel restrictions were in place from March 24 to May 31, 2020. Case records were collected retrospectively and analyzed for demographics, type of initial treatment, length of delay in presentation, microbiological diagnosis, clinical course, and final treatment outcome. RESULTS: The mean age of the patients was 49.2 years, with most of them (61.2%) being male. Forty-one patients (15.9%) did not receive any treatment for at least a week after the onset of symptoms. One hundred eight patients (41.9%) presented with severe ulcer (32 had a frank perforation). Resolution of the infection was achieved only in 103 patients (45.6%). A total of 90 patients (39.8%) with ulcers had a perforation, yet only 29 patients (32.2%) could receive keratoplasty because of the unavailability of donor tissues. At the end of 6-month follow-up, 47 patients had anatomical failure (loss of globe) and 12 additional patients had functional failure (total permanent vision loss). CONCLUSIONS: Delay in presentation and acute shortage of donor corneal tissues for emergency keratoplasty because of the COVID-19 pandemic had a grave impact, resulting in irreversible blindness in a significant number of patients.

Updated safety precautions and guidance on eye banking procedures during the coronavirus disease 2019 pandemic.

PURPOSE OF REVIEW: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious coronavirus causing the COVID-19 pandemic. Although airborne spread through infectious respiratory droplets is the primary source of transmission, recent literature has suggested the ocular surface may be able to harbor viral particles. Here, we aim to discuss how SARS-CoV-2 affects the ocular surface and updated guidance on how SARS-CoV-2 transmission should be considered in the setting of eye banking and corneal transplantation procedures. RECENT FINDINGS: SARS-CoV-2 RNA can be found on the ocular surface, which may suggest the eye as a site of viral replication. However, there is poor correlation between PCR positivity on the ocular surface and ocular symptoms. To date, although viral particles can be found on the ocular surface, use of standard antiseptic procedures during corneal tissue procurement appears to sufficiently reduce viral load. In addition, preprocedure testing may further decrease the chances of transplanting an infected cornea without significantly impacting the overall accessibility to corneal tissue by decreasing the donor pool. SUMMARY: Corneal transplantation remains a well tolerated and highly successful procedure with no evidence of viral transmission with transplantation. Although the ocular surface has the required receptors to allow for viral replication, there is no clear evidence that the eye is a site for primary viral infection.

Impact of the COVID-19 Pandemic on Keratoplasty and Corneal Eye Banking.

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.