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1.
Indian J Ophthalmol ; 70(10): 3669-3672, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36190069

RESUMO

We aimed to develop a novel and effective technique for creating a smooth deep lamellar dissection of the cornea using a femtosecond (FS) laser for deep anterior lamellar keratoplasty (DALK), we conducted a retrospective eye bank study. Thirteen fresh human corneas were mounted on an artificial anterior chamber, and deep lamellar cuts were made with a 500-kHz VisuMax FS laser at a level of 50-80 µm anterior to the Descemet's membrane (DM). A posterior diameter of 8 mm with a side cut angle of 110° was used for the anterior penetrating side cut. The anterior lamellar tissue was bluntly dissected. The residual posterior stromal beds and side cuts were examined with microscopy and intraoperative optical coherence tomography (OCT) and post-cut endothelial cell evaluations. All corneas revealed a smooth residual posterior stromal bed without any visible irregularities or ridges by microscopy and OCT imaging. Six corneas were suitable for post-cut endothelial cell evaluation 2 days after laser cut, with no significant endothelial cell loss post-laser and blunt dissection of the posterior stroma. FS laser deep lamellar keratoplasty utilizing an ultrafast laser to produce a smooth deep stromal dissection followed by blunt dissection and removal of the anterior stromal tissue yields a consistent and smooth residual stromal bed. The creation of a smooth lamellar dissection in the deep posterior cornea may result in more consistent DALK without the need for air bubble or manual baring of DM that has the risk for DM perforation.


Assuntos
Transplante de Córnea , Córnea/cirurgia , Transplante de Córnea/métodos , Bancos de Olhos , Humanos , Ceratoplastia Penetrante/métodos , Lasers , Estudos Retrospectivos
2.
BMJ Open Ophthalmol ; 7(Suppl 1): A5, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-36161811

RESUMO

*Correspondence - Arthur Hammer: a.hammer@nhs.net PURPOSE: We describe 2 cases who underwent uneventful DMEK surgery but presented delayed recovery and had confirmed cornea guttata in the donor tissues. Both patients received a cornea from the same donor. CASES: A 78-year-old man with Fuchs' dystrophy underwent triple procedure (phaco + IOL + DMEK) in his right eye and presented persistent central corneal oedema despite fully attached graft. Early rejection was suspected, and the oedema took 6 weeks to resolve completely at which point we confirmed central guttata in the donor tissue. His contralateral eye underwent DMEK surgery six months before and had clear cornea with no guttata. A 74-year-old man with corneal scarring and aphakic bullous keratopathy underwent DMEK surgery and had a persistent corneal oedema postoperatively even after initial rebubbling for a partially peripherally detached graft. Corneal oedema persisted for two months postoperatively despite full attachment and guttata identified. Both donor corneas were reported to have endothelial cell counts of 2600 cells/mm2 preoperatively. In both cases confocal microscopy confirmed the presence of guttata in the donor graft. An imaging assessment from the donor tissues was performed with the eye bank and review from the literature is discussed. CONCLUSION: Fuchs' dystrophy appears relatively common in the general population (4% in the USA); thus, a proportion of this condition might be expected in donor corneas. Identification of guttae in donor corneas with early stages of Fuchs' dystrophy appears challenging. Current modalities of graft material screening (which appears to be standardised across Europe) are more orientated toward measuring the endothelial cell density and morphology and less toward detection of guttae. However, we believe this challenging case may not be isolated and thus improvement of eye bank screening would be of critical value to detect early Fuchs' dystrophy in donor tissues and therefore improve graft survival.


Assuntos
Edema da Córnea , Bancos de Olhos , Idoso , Córnea/cirurgia , Edema da Córnea/diagnóstico , Endotélio Corneano , Distrofia Endotelial de Fuchs , Humanos , Masculino
3.
Curr Eye Res ; 47(11): 1496-1497, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36095302

RESUMO

PURPOSE: By splitting a donor cornea into an anterior and a posterior donor lamella, the need for donor tissue can be reduced in times of lack of donors. Current eye bank regulations limit the use of each donor cornea to one recipient. METHODS: The anterior lamella not applied to the patient after each sterile DMEK preparation performed was stored for one week and was microbiologically controlled on day 7. RESULTS: Between October 2020 and December 2021, microbiological controls of 108 consecutive anterior lamellae were performed at the Department of Ophthalmology, University of Duesseldorf, without any contamination found. CONCLUSION: Our data suggest split-cornea transplantation is a microbiologically safe procedure.


Assuntos
Transplante de Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Córnea/cirurgia , Transplante de Córnea/métodos , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Bancos de Olhos , Humanos , Doadores de Tecidos
4.
Sci Rep ; 12(1): 14834, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-36050445

RESUMO

Quantitative evaluation of the human corneal grafts stored in the tissue banks is usually limited to endothelial cell density and central thickness. Swept-source OCT (SS-OCT) is capable of measuring the central curvatures of the corneal tissue prepared for transplantation without loss of sterileness, providing insights on its refractive state. The aim of the paper is to compare in vitro SS-OCT measurements with pre-excision values. Hand-held keratometry and ultrasound pachymetry was performed on 22 corneas before excision of corneoscleral button and insertion in the vial with Eusol-C solution (AlchimiaS.r.l, Nicolò, Italy). After 12 to 36 h of hypothermic storage the corneas were examined within the vials with custom built SS-OCT system maintaining a sterile environment. The anterior and posterior central curvatures, and central corneal thickness (CCT) were measured. Rotation of the corneoscleral button was controlled by making a 6-o'clock mark during excision. Mean pre-excision CCT was 626.45 ± 28.71 µm and 468.05 ± 52.96 µm when measured with SS OCT (r = 0.55; p < 0.001). Respective values for average keratometry were 7.74 ± 0.39 mm and 7.92 ± 0.57 mm (r = 0.6; p = 0.22). Although high differences were observed in corneal thickness, keratometric radius of curvature at the flat (r = 0.42; p < 0.001) and steep (r = 0.62; p = 0.014) meridian of the anterior corneal surface, as well as corneal anterior astigmatism (r = 0.3; p < 0.001), showed good correlation with pre-excision values. SS-OCT is capable of providing quantitative evaluation of the human corneal grafts in hypothermic storage. Good correlation between curvature measurements before excision and during banking in the vial indicates its clinical utility.


Assuntos
Doenças da Córnea , Transplante de Córnea , Córnea/cirurgia , Paquimetria Corneana , Bancos de Olhos , Humanos , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica
5.
Indian J Ophthalmol ; 70(9): 3289-3293, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36018105

RESUMO

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.


Assuntos
COVID-19 , Transplante de Córnea , Obtenção de Tecidos e Órgãos , Adulto , Idoso , Córnea , Bancos de Olhos , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Doadores de Tecidos
6.
Cornea ; 41(12): 1539-1544, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36036663

RESUMO

PURPOSE: The purpose of this study was to evaluate outcomes of Descemet stripping automated endothelial keratoplasty comparing exchange with fresh intermediate-term cold storage solution after lenticule preparation versus reuse of the original solution in the Cornea Preservation Time Study. METHODS: In the Cornea Preservation Time Study, 508 donor corneas had lenticules prepared by the eye bank with fresh solution exchange (Fresh group) and 283 with reuse of the original solution (Original group). Storage time for all donors was ≤11 days. Graft success rates, central endothelial cell loss at 3 years, and frequency of positive donor rim cultures were compared between the 2 groups. RESULTS: The 3-year graft success rate (95% confidence interval) was 93.4% (90.7%-95.3%) in the Fresh group and 95.2% (91.8%-97.2%) in the Original group (adjusted hazard ratio for graft failure = 0.64, 95% confidence interval, 0.33-1.24, P = 0.19). The mean percentage endothelial cell loss was significantly greater in the Fresh group versus Original group (45% ± 22% vs. 38% ± 20%, respectively, P = 0.004). Cultures were positive in 4 (1.5%) of 267 donor rims (3 fungal and 1 bacterial) in the Fresh group and in 4 (2.5%) of 158 in the Original group ( P = 0.57). There were 2 postoperative infections in the Original group and none in the Fresh group. CONCLUSIONS: The use of the original intermediate-term cold storage solution did not reduce the 3-year graft success rate compared with exchanging with fresh solution after lenticule preparation for Descemet stripping automated endothelial keratoplasty, while the frequency of positive donor rim cultures did not significantly differ between groups.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Distrofia Endotelial de Fuchs , Humanos , Distrofia Endotelial de Fuchs/cirurgia , Estudos de Tempo e Movimento , Córnea/cirurgia , Bancos de Olhos , Doadores de Tecidos , Endotélio Corneano
7.
JAMA Ophthalmol ; 140(9): 885-888, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35900747

RESUMO

Importance: Endothelial cell density in corneal donor eyes remains a critical component in selecting tissue suitable for corneal transplant. Objective: To describe an anomaly in endothelial cell density discovered in a large cohort of corneal donor eyes. Design, Setting, and Participants: Donor information for this cross-sectional study was obtained from the CorneaGen eye bank for donors from June 1, 2012, to June 30, 2016. Endothelial cell density was reported by eye bank technicians for each eye. The retrospective donor data set included donor demographics, endothelial cell count, time of death, medical and surgical history, and suitability for transplant. The donor data set contained information on donated eyes over the 4-year period. Main Outcomes and Measures: Endothelial cell-density heat map, 2-dimensional binned plots, and bayesian change point analysis. Results: A total of 48 207 donated eyes were evaluated. Mean (SD) cell count was 2717 (448) cells/mm2, and mean (SD) donor age was 58 (13) years. Heat maps using 2-dimensional binned plots demonstrated accentuated endothelial cell density results particularly at and immediately above 2500 cells/mm2 with a small gap right under this figure. A bayesian change point analysis revealed a change point at exactly this location as well. Conclusions and Relevance: Data from this cross-sectional study suggest a discontinuity in endothelial cell-density measurements just below 2500 cells/mm2. This anomaly suggests that the semiautomated counting technique used in this cohort preferentially skipped over measurements just below this cutoff. Whether this represents an automation error, or more likely, a subjective human bias, requires further study.


Assuntos
Endotélio Corneano , Sobrevivência de Enxerto , Teorema de Bayes , Contagem de Células , Estudos Transversais , Células Endoteliais , Bancos de Olhos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Doadores de Tecidos
8.
Int Ophthalmol ; 42(12): 3681-3690, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35612689

RESUMO

AIM: To explore the attitudes, preferences, and barriers of DMEK among corneal specialists in Saudi Arabia. METHOD: An anonymous survey was sent through an online platform to members of the Saudi Ophthalmological Society. The survey was designed to capture data covering: demographic data, practice patterns of keratoplasty techniques, DMEK technique preferences, barriers, and facilitators to performing DMEK. RESULTS: Thirty-five (33% response rate) surgeons participated in the questionnaire. Sixty-eight percent were in practice for less than or equal to 10 years. Thirteen surgeons were performing DMEK. Participating in any training capacity was observed among surgeons who performed DMEK (92%). The main selection criteria for this procedure were patients with normal anterior chamber anatomy (77%). The main barrier against DMEK adoption among surgeons who do not perform the procedure was the lack of experience (91%). Strategies to help begin performing DMEK were eye banks support (prepared grafts, backup tissue for inadvertent loss), access to wet-lab training courses, and higher surgical volume. CONCLUSION: DMEK is not highly performed among corneal specialists in Saudi Arabia; however, there is evident interest in adopting this technique. Strategies toward filling the gap of lacking experience would facilitate the adoption of the procedure. Eye banks play a crucial role by providing prepared tissues, which would lessen part of the technical difficulty.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Cirurgiões , Humanos , Lâmina Limitante Posterior/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Bancos de Olhos , Córnea/cirurgia , Endotélio Corneano , Estudos Retrospectivos
9.
Arq Bras Oftalmol ; 85(3): 277-285, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35544944

RESUMO

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.


Assuntos
COVID-19 , Transplante de Córnea , Brasil/epidemiologia , COVID-19/epidemiologia , Córnea/cirurgia , Bancos de Olhos , Humanos , Pandemias/prevenção & controle , Política Pública , Doadores de Tecidos
10.
Cornea ; 41(11): 1444-1446, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-35184124

RESUMO

PURPOSE: The aim of this study was to evaluate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) tissue preparation using a glasses-assisted 3-dimensional (3D) display system and to compare it with a conventional surgical microscope. METHODS: Healthy pairs of human corneas suitable for penetrating keratoplasty surgery were selected for this study. The tissues were randomly divided into 2 groups. Each pair of corneas had 1 cornea (group 1) prepared with NGENUITY (Alcon) with a 5-second staining time with vision blue, and the fellow cornea (group 2) was prepared using a OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) with a 30-second staining time. DMEK graft preparation time, speed of stripping, graft width, and endothelial cell loss were evaluated. RESULTS: Twenty-eight pairs of corneas were included in this study. The graft preparation time was significantly higher in the 3D group than in the conventional group (498 ± 147 vs. 418 ± 85 seconds, P value = 0.031). The mean speed of stripping was 0.59 ± 0.081 mm/s in group 1 and 0.089 ± 0.005 mm/s in group 2 ( P value = 0.024). The mean endothelial cell density in group 1 and group 2 before tissue preparation was 2162 ± 115.21 and 2153 ± 122.45, respectively ( P value > 0.1). After tissue preparation, the endothelial cell density reduced to 1911 ± 150.72 in group 1 and 1998 ± 90.72 in group 2 ( P value = P value > 0.05). The graft width was 5.05 ± 0.71 mm in group 1 and 4.92 ± 0.23 mm in group 2 ( P value > 0.05). CONCLUSIONS: DMEK tissue preparation with 3D display system NGENUITY is feasible with a slightly increased preparation time. The improved visualization allows a reduced staining time that could be beneficial for eye banks because it may reduce the toxic effect of staining colorants.


Assuntos
Lâmina Limitante Posterior , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Contagem de Células , Córnea , Lâmina Limitante Posterior/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Endotélio Corneano/transplante , Bancos de Olhos/métodos , Humanos , Doadores de Tecidos
11.
Cornea ; 41(6): 757-765, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35184122

RESUMO

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.


Assuntos
COVID-19 , Transplante de Córnea , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Bancos de Olhos , Humanos , Ontário/epidemiologia , Pandemias , Doadores de Tecidos
12.
BMC Ophthalmol ; 22(1): 17, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012494

RESUMO

BACKGROUND: With the increasing demand for corneas, eye banks must optimize the tissue donation, collection, and selection process. This retrospective monocentric study analyzed the approval rates for corneal donation and the origin of and reasons for discarding donor corneas from 2010 to 2019. METHODS: Data included the number of deceased, approval or rejection by the family for corneal donation and contraindications. Corneal grafts were included from all deceased persons who were full-body and multi-organ donors at the Saarland University Medical Center (UKS) and from external institutions. Additional analyzed parameters included endothelial cell count (ECC), blood sample serology for infections, and conjunctival swab testing . RESULTS: A total of 1748 corneoscleral buttons were harvested from 10,265 deceased persons (17% with no contraindication) at the UKS between 2010 and 2019, with a consent rate of 23.3%. The number of keratoplasties increased from 136 in 2010 (15% of the deceased, total = 925) to 251 in 2019 (21%, total = 1214). Both the general and department-specific data showed similar percentages for corneal donation over the years, with intensive care and palliative units recently providing the most corneas. The increase in the number of corneas processed by the cornea bank over the years (368 in 2010 compared with 857 in 2019) was linked both to a better internal supply in 2010 (262, 71.2% of the total) compared with 2019 (519, 60.6%) and to an external supply by reinforcement of cooperation with external hospitals, including Luxembourg in 2010 (106, 28.8% of the total) compared with 2019 (338, 39.4%). A total of 195 of 377 corneas (52%) were discarded in 2009 compared with 260 out of 715 (36%) in 2019. The main reasons for discarding were low ECC (36% of discarded corneas in 2009; 11% in 2019), positive conjunctival swab (11% in 2009; 13% in 2019), and blood sample serology (6% in 2009 and in 2019). CONCLUSION: Despite an increasing number of donors, the demand for corneas is still rising. Improved cooperation with internal departments and with external clinics has led to an increasing number of explanted corneas. The main reason for discarding corneas was low ECC, followed by a positive conjunctival swab for fungal or bacterial contamination and serology. Increased donation rates and continued improvements in collection and selection processes are necessary to cover the high demand for corneas.


Assuntos
Transplante de Córnea , Bancos de Olhos , Córnea , Humanos , Estudos Retrospectivos , Centros de Atenção Terciária , Doadores de Tecidos , Universidades
13.
Cornea ; 41(2): 224-231, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35037905

RESUMO

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.


Assuntos
COVID-19/epidemiologia , Extração de Catarata , Transplante de Córnea , Complicações Pós-Operatórias/epidemiologia , SARS-CoV-2/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , Teste de Ácido Nucleico para COVID-19 , Estudos de Casos e Controles , Bancos de Olhos/estatística & dados numéricos , Feminino , Florida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/genética , Doadores de Tecidos/estatística & dados numéricos , Transplantados/estatística & dados numéricos
14.
Indian J Ophthalmol ; 70(2): 511-515, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35086227

RESUMO

PURPOSE: To examine the utilization patterns of cornea procured from diseased individuals ≥75 years of age at an eye bank in western India. METHODS: In this retrospective study, data from 1,217 eyes of 653 donors with age ≥75 years were reviewed from October 2008 to December 2019. Donor age, lens status, endothelial cell count (ECD), utilization of the tissue for transplantation or non-clinical purposes (e.g., research, training/discarded), and causes of non-utilization were noted. RESULTS: The mean age of the donors was 80.9 ± 4.6 years and the tissue utilization rate was 36.5% (445 out of 1,217 eyes). The eyes used for keratoplasty procedures had a lower donor age (79.6 ± 5.7 vs. 81.5 ± 5.1; P < 0.001), a higher endothelial cell count (2493 ± 531 vs. 2034 ± 581; P < 0.001), and were more often phakic (61% vs. 36.6%) compared to the unused group. A multivariable logistic regression analysis showed that the likelihood of tissue utilization for keratoplasty was 13% higher with every 100-cell increment in donor ECD (odds ratio [OR] = 1.13, 95% CI = 1.10-1.16, P < 0.001) and 33% lower with having a pseudophakic status in the donor eye (OR = 0.67, 95% CI = 0.52-0.87, P = 0.03). Age was not a significant determinant of tissue utilization when used in the same multivariable model. CONCLUSION: More than one-third of the eyes (36.5%) can be utilized even when the donors are above 75 years of age. Eyes that were more likely to be utilized for keratoplasty were phakic and had a significantly higher ECD; age was not a determinant in tissue utilization.


Assuntos
Transplante de Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Idoso , Idoso de 80 Anos ou mais , Contagem de Células , Córnea/cirurgia , Endotélio Corneano , Bancos de Olhos , Humanos , Estudos Retrospectivos , Doadores de Tecidos
15.
Curr Eye Res ; 47(4): 493-504, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34986709

RESUMO

PURPOSE: To summarize the graft loading, transporting and delivery devices used for endothelial keratoplasty (EK). METHODS: A literature search of electronic databases was performed. RESULTS: New techniques and devices have been introduced and implemented to prepare, load, transport and transplant the grafts for EK. The advantages are not only limited to the surgical theatre but also widely spread across the eye banking field. Investigation of advanced materials and designs have been rapidly growing with continuous evolution in the field of eye banking and corneal transplantation. Innovative techniques and modern devices have been evaluated to reduce the endothelial cell loss and increase the precision of the transplant in order to benefit both surgeons and the patients. CONCLUSIONS: It is extremely important to reduce any potential wastage and optimize the use of every available donor cornea due to the limited availability of healthy cadaveric donor corneas required for transplants. As a result, the use of pre-cut and pre-loaded grafts supplied by the eye banks in calibrated devices have been gaining momentum. Innovation in the field of bioengineering for the development of new devices that facilitate excellent clinical outcomes along with reduction in learning curve has shown promising results.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Células Endoteliais , Endotélio Corneano , Bancos de Olhos , Humanos , Doadores de Tecidos
16.
Indian J Ophthalmol ; 70(2): 523-528, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35086230

RESUMO

PURPOSE: To evaluate and compare the biomechanical properties of the eye bank-prepared and surgeon prepared Descemet stripping automated endothelial keratoplasty (DSAEK) tissues. METHODS: In this laboratory study, corneal tissues for research were randomly allocated in the following groups: a) surgeon-cut DSAEK and b) eye bank-prepared (pre-cut and pre-loaded) DSAEK. Endothelial cell loss (ECL), immunostaining for tight junction protein ZO-1, elastic modulus, and adhesion force were investigated. RESULTS: ECL was not found to be significantly different between surgeon-cut DSAEK (7.8% ±6.5%), pre-cut DSAEK (8.6% ±2.3%), and pre-loaded DSAEK (11.1% ±4.8%) (P = 0.5910). ZO-1 was expressed equally across all groups. Surgeon-cut DSAEK grafts showed a significantly higher elastic modulus compared to pre-cut and pre-loaded DSAEK groups (P = 0.0047 and P < 0.0001, respectively). Adhesion force was significantly greater in the surgeon-cut DSAEK compared to pre-cut (P < 0.0001) or pre-loaded DSAEK groups (P = 0.0101). CONCLUSION: The laboratory data on the biomechanics of DSAEK grafts suggests that surgeon-cut DSAEK grafts present higher elastic modulus and adhesion force compared to eye bank-prepared DSAEK grafts.


Assuntos
Doenças da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Cirurgiões , Córnea/cirurgia , Doenças da Córnea/cirurgia , Endotélio Corneano/transplante , Bancos de Olhos , Humanos , Projetos Piloto
17.
Cornea ; 41(5): 664-668, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34839330

RESUMO

PURPOSE: The purpose of this study was to evaluate agreement between eye banks (EBs) and an image analysis reading center on endothelial cell density (ECD) determinations using the same image analysis method. METHODS: The Cornea Image Analysis Reading Center (CIARC) determined ECD with a single experienced analyst on EB-obtained central endothelial images from donors intended for keratoplasty from 2 eye banks, Eversight and Lions VisionGift, using the Konan center analysis method. The EBs performed ECD determination on their respective sets of images using the same analysis method with experienced eye bank technicians. RESULTS: The mean age of the 200 donors was 54 years (range 30-75 years). Seventy (35%) of the 200 patients were women, and 57 (29%) were diabetic. The mean ECD was 10 cells/mm2 greater by the EBs than by CIARC (P = 0.39), with 95% limits of agreement of [-304 to 323 cells/mm2]. The mean difference was not substantially changed when the difference between EBs and CIARC ECD was adjusted for sex, donor age, donor diabetes, CV, HEX, number of cells analyzed, and EBs as a random effect (estimated mean difference of 20 cells/mm2 after adjustment in a linear mixed model; P = 0.73). The EB-determined preoperative ECD was within 10% of the CIARC-determined ECD for 178 (89%) image sets, with 15 (8%) higher by >10% and 7 (3%) lower by >10%. CONCLUSIONS: Well-trained eye bank technicians achieve comparable results for ECD determination with an experienced image analyst from an image analysis reading center when the same image analysis method is used.


Assuntos
Bancos de Olhos , Leitura , Adulto , Idoso , Contagem de Células , Perda de Células Endoteliais da Córnea/diagnóstico , Células Endoteliais , Endotélio Corneano , Feminino , Humanos , Pessoa de Meia-Idade , Doadores de Tecidos
18.
Cornea ; 41(2): 238-242, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34852410

RESUMO

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.


Assuntos
Teste de Ácido Nucleico para COVID-19/estatística & dados numéricos , COVID-19/epidemiologia , Túnica Conjuntiva/virologia , Córnea/virologia , Ceratoplastia Penetrante , SARS-CoV-2/isolamento & purificação , Doadores de Tecidos/estatística & dados numéricos , Adulto , Teste para COVID-19 , Causas de Morte , Seleção do Doador , Bancos de Olhos/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Ceratoplastia Penetrante/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , RNA Viral/genética , SARS-CoV-2/genética
19.
Cornea ; 41(6): 746-750, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34320599

RESUMO

PURPOSE: To study the causes of non-utilization of donor corneas and assess whether non-utilized tissues differ from utilized tissues with regard to age and endothelial cell density (ECD). METHODS: Aretrospective, cross-sectional analyses of all donor corneas collected from a network of 4 eye banks of a tertiary eye care institute in India during a 1-year period (January to December 2019) was conducted. All donor corneas were assessed for tissue quality by slit lamp evaluation, donor age, and specular microscopy. The causes of non-utilization and effect of donor age and ECD on tissue utilization were studied. RESULTS: A total of 10,969 corneas were harvested during the study period; 4618 (42.1%) tissues were discarded. The main causes of non-utilization were poor tissue quality accounting for 86.16% (n = 3979) of all discarded corneas. The mean donor age was 50.7 ± 2.9 years and 63.3 ± 2.3 years for used and discarded corneas, respectively (P < 0.0001). The mean ECD of donor tissues was significantly (P < 0.0001) higher in the utilization group (2787.3 ± 77.4 cells/mm2) than that in the non-utilization group (2394.4 ± 82.5 cells/mm2). Donor age and ECD and their interaction were significant (P < 0.001) predictors of tissue utilization rate. CONCLUSIONS: Donor age and ECD and their interaction were significantly associated with the rate of utilization of donor corneal tissues.


Assuntos
Transplante de Córnea , Bancos de Olhos , Contagem de Células , Córnea , Estudos Transversais , Células Endoteliais , Endotélio Corneano , Humanos , Pessoa de Meia-Idade , Doadores de Tecidos
20.
Cornea ; 41(3): 390-395, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34483277

RESUMO

METHODS: We conducted grounded theory semistructured interviews, purposively inviting participants until themed saturation was met. Sentiment analysis was used to determine opinion. RESULTS: We interviewed n = 92 global eye tissue and eye bank professionals. We determined that corneal tissue, which is exported, costs between US $100 and US $6000 or is provided as gratis. Collectively, interviewees indicated that, globally, there were no fixed fee structures in place, and the fee was influenced by multiple factors on both export and import sides. They indicated that ultimately corneas were allocated based on the importers' ability to pay the price determined by the exporting eye bank. DISCUSSION: Allocation of corneal tissue, which is exported, is influenced by the fees charged by the exporters to meet their bottom line and the funds available to importers. Therefore, export allocation is not equitable, with those who can pay a higher fee, prioritized. Steps to guide and support exporters with the development of fee structures that promote equitable allocation are essential. This will assist both export and import eye bank development, corneal tissue access development, and those awaiting a corneal transplant.


Assuntos
Córnea/cirurgia , Transplante de Córnea/estatística & dados numéricos , Bancos de Olhos/provisão & distribuição , Alocação de Recursos/organização & administração , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/organização & administração , Humanos
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