The aftermath of the COVID-19 pandemic on access to corneal transplant procedures in Morocco

ABSTRACT

Purpose: The COVID-19 pandemic led to disrupted corneal supply to countries tributary to foreign eye bank donations. The authors carried out the first retrospective, observational study to assess the impact of the pandemic on corneal tissue supply and quality in Morocco, by comparing the surgical patterns during the pre-pandemic time and the first year of the pandemic at the only tertiary eye center performing keratoplasty in Morocco. Methods: A retrospective analysis comparing the years 2019 and 2020 ( January 1st to December 31st) was performed based on electronic health records database from the department of Ophthalmology at Cheikh Zaid International Hospital.Quantitative analysis evaluated the numbers of keratoplasties performed, the number procedures for therapeutic or tectonic purposes, the numbers of delivered corneal tissue, numbers of patients on the waiting list. Quality assessment of the grafts was based on the mean endothelial cell density count provided by the supplier, prior to corneal surgery. The comparison was based on a Chi2 test with p<0.05 considered statistically significant. Statistical study was performed using Jamovi (The Jamovi project2021,Version 1.6[Computer Software]) Results: Out of a total of 345 patients registered on the corneal transplant list on 2019, 252 patients underwent keratoplasty (73%) with 4,4 % for tectonic or therapeutic purposes, whereas out of 507 patients on the list on 2020, 160 received keratoplasty (31,55%) with 13,7% in a context of emergency. The waiting list grew from 293 patients in 2019 to 453 in 2020 marking an increase of 21,4 %. A statistically significant decrease in the number of corneal tissue received at our center was noted, with a mean of 4,8 (+/-4,23) per week in 2019 and 2,9 (+/-3,02) per week in 2020 (p=0,02).All corneal tissue was exclusively provided by three US eye banks. Mean endothelial cell density count prior to surgery was not statistically different between 2019 ( 2699 c/mm2 +-255) and 2020 ( 2668 c/mm2266),(p= 0,22). Conclusions: These results reflect the imbalance between corneal demand and supply creating a disruption of the corneal tissue chain in Morocco. Given the exceptional activity of the local Eye bank of Morocco due to numerous challenges, and the scarcity of centers that perform keratoplasty, Morocco witnesses a gap between corneal blindness and access to keratoplasty which was further enlarged during the pandemic.