Trends in keratoplasty from central and northern India. Part II: Types of keratoplasty.

PURPOSE: To report the types of keratoplasty and analyze trends over a period of two decades in central and northern India. METHODS: This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and north India from 2005 to 2021. The indications and various keratoplasty procedures were compared between 2005-2012 and 2013-2021 to analyze the trend. RESULTS: A total of 13,223 corneal grafts were performed, of which therapeutic penetrating keratoplasty (TPK) (5719, 43.3%) was the most common procedure, followed by optical penetrating keratoplasty (OPK) (5528, 41.8%), Descemet stripping endothelial keratoplasty (DSEK) (1279, 9.7%), deep anterior lamellar keratoplasty (DALK) (376, 2.8%), Descemet membrane endothelial keratoplasty (DMEK) (215, 1.6%), patch grafts (75, 0.6%), and keratoprostheses (31, 0.2%). Overall, OPK procedures decreased (-14.1%, P < 0.001), but TPK (+3.1%, P < 0.019), DSEK (+7.1%, P < 0.001), and DMEK (+1.9%, P < 0.001) procedures increased. Although there was an increasing trend in the use of DALK (+0.8%, P < 0.083) and keratoprostheses (+0.3%, P = 0.074) procedures, the trends were not statistically significant. CONCLUSION: In keeping with worldwide trends, an increasing trend in lamellar keratoplasties was observed in central and northern India during the past decade. The trend was significant for DSEK. However, as corneal ulcers and scars were the major indications for keratoplasty, TPK and OPK remained the most common procedures.

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.

The New Zealand National Eye Bank study: trends in the acquisition and storage of corneal tissue over the decade 2000 to 2009.

PURPOSE: To evaluate trends in the acquisition, storage, and utilization of donated corneal tissue in New Zealand, 2000 to 2009. METHODS: The New Zealand National Eye Bank records were analyzed for the decade January 2000 to December 2009. Variables analyzed included donor demographics (age, sex, and ethnicity), donor source, donor cause of death, death-to-preservation interval (DPI), corneal storage time, tissue contamination, endothelial assessment, cornea suitability for transplantation, and corneal tissue utilization. RESULTS: A total of 1268 eye donors were identified during the 10-year period. Overall, 36% (n = 457) were female and 64% male (n = 813). Median donor age was 67 years, and 23% of donors were younger than 50 years (range, 5-90 years). There was a decrease in donor age over the decade (P = 0.006). The median DPI was 18.5 hours. No relationship was identified between cornea suitability for transplantation and DPI (P = 0.28) or donor gender (P = 0.54). There was a low microbial contamination rate (1%). Human immunodeficiency virus, hepatitis B, or hepatitis C serology was positive in 48 donors (4%). Overall, 90% of corneas were suitable for transplantation with a high utilization rate (88%). A novel association was identified between male sex and lower corneal endothelial cell density (P = 0.03). CONCLUSIONS: This New Zealand National Eye Bank analysis identified trends in the acquisition, storage, and utilization of donated corneal tissue throughout New Zealand over the past decade and provides valuable additional information to the international eye bank data.

The past twenty-five years in eye banking.

PURPOSE: This review of milestones and challenges in eye banking describes efforts made by dedicated eye bankers to ensure the quality and quantity of corneal tissue for corneal blind patients over the last 25 years. METHODS: This account is the result of the recollection of the author, discussions with eye bankers, and a review of the literature, public documents, and Eye Bank Association of America (EBAA) records. RESULTS: A measure of the success of eye banking is the fact that corneal transplant surgery is now scheduled as an elective procedure. Corneal tissue has also enjoyed a stellar safety record. This is due in part to the establishment of comprehensive medical standards by the EBAA, the accreditation of eye banks, and the training and certification of eye bank technicians. CONCLUSION: Advancements in eye banking over the last 25 years have improved the quality of life of several hundred thousand corneal blind persons in this country. More efforts must be made in the future to eliminate corneal blindness internationally.

Eye banking in America.

In 1961, the Eye Bank Association of America (EBAA) was developed to promote universal standards for the procurement of eye tissue. Over the last 30 years, the EBAA has had to change its original guidelines to include medical standards, technical personnel, updates in serology testing, and public relations. Certified technicians are required to perform procurement after careful donor chart review, where they must also review the lab results and check the postmortem blood sample to see if it tested positive for the human immunodeficiency virus.

Modern eye banking.

Ophthalmology has accepted the primary responsibility for supervision and control of the medical aspect of eye banking. Operating within the framework of the American Academy of Ophthalmology and the Eye Bank Association of America, Medical Standards have been promulgated which recognize the need for standardization and quality control throughout the eye banking procedures. The role of the Medical Director and the Medical Standards Committee has been strengthened. Challenges to be met include increasing the supply of donor tissue, the development of a statistical data base, research to expand endothelial viability, the incorporation of new technology, and the necessity to develop resources to combat an increasingly hostile financial and political environment in our nation's hospitals.