|Year : 2017 | Volume
| Issue : 3 | Page : 133-136
Evaluation of quality and utility rate of donor corneal tissue received at tertiary eye care center
Shwetambari G Singh, Dipali R Satani, Amit P Patel, Dharmil C Doshi
Department of Ophthalmology, C.H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
|Date of Web Publication||11-Oct-2017|
Shwetambari G Singh
204, Neeldeep Apartments, Opposite Suvidha Shopping Centre, Paldi, Ahmedabad - 380 007, Gujarat
Source of Support: None, Conflict of Interest: None
Purpose: This study was performed to evaluate quality and utility rate of donor corneal tissue received at tertiary eye care center. Materials and Methods: All tissues retrieved by our eye bank from January 2012 to December 2015 were evaluated. Donor age, lens status, utilization of the tissue for optical transplantation, therapeutic transplantation, or nonclinical purposes (e.g., research, training/discarded) and causes of using tissue for nonclinical purposes were noted. A careful chart review was performed to determine the precise cause of exclusion of each tissue from transplantation. Results: A total of 413, 454, 430, and 412 corneas were retrieved in the years 2012, 2013, 2014, and 2015, respectively. In study duration, 54% of tissues received were from donors aged more than 70 years, and 49.5% tissues were pseudophakic. The mean corneal utility rate of our study was 42%. In the year 2013, corneal utility rate was least (33.30%), when we received maximum number of pseudophakic and elderly (>70 years) donor eyes. Most common cause of clinical nonutility of the tissue was poor quality (37.3%) followed by medical history of the donor (15.4%) and safety reasons (2%). Conclusion: Retrieval of more number of pseudophakic and older donor eyes with poor quality lead to relatively lower tissue utility rate in our study. Eye donation awareness programs targeting multispecialty hospitals or trauma centers can be more rewarding to receive better quality younger donor eyes.
Keywords: Donor age, donor corneal tissue, eye donation, pseudophakic donor eye
|How to cite this article:|
Singh SG, Satani DR, Patel AP, Doshi DC. Evaluation of quality and utility rate of donor corneal tissue received at tertiary eye care center. J Clin Ophthalmol Res 2017;5:133-6
|How to cite this URL:|
Singh SG, Satani DR, Patel AP, Doshi DC. Evaluation of quality and utility rate of donor corneal tissue received at tertiary eye care center. J Clin Ophthalmol Res [serial online] 2017 [cited 2022 Jul 4];5:133-6. Available from: https://www.jcor.in/text.asp?2017/5/3/133/216434
Corneal blindness is a leading cause of preventable blindness in India. Corneal transplantation with good quality donor corneal tissue is the mainstay of management of corneal blindness. Transplantation performed with suboptimal corneal tissue can lead to primary or secondary graft failure which instead of reducing blindness increases the financial burden of the patient and community. With increasing awareness regarding eye donation in a general population and improving the infrastructure of eye banks in India, corneal retrieval is increasing but not enough to meet the perceived need for harvesting 200,000 tissues annually to do 100,000 corneal transplants a year. Although there is a quantitative improvement in data of corneal retrieval, qualitative improvement is difficult to achieve. We performed a retrospective study to evaluate quality and utilization rate of corneal tissues received by our eye bank at a tertiary eye care hospital at Ahmedabad, Gujarat.
| Materials and Methods|| |
After taking ethical clearance from the Institutional Review Board, a retrospective study was carried out with the help of computerized records of our eye bank. Our eye bank receives eyes from Ahmedabad city of Gujarat state having a population of 65 lakhs. In Ahmedabad city apart from our eye bank, five other eye banks are actively involved in retrieving corneas. All tissues retrieved from January 2012 to December 2015 were evaluated. Donor age, lens status of the donor tissue, utilization of the tissue for optical transplantation, therapeutic transplantation, or nonclinical purpose (e.g., research, training/discarded) and causes of using tissues for the nonclinical purpose were noted. A careful chart review was performed to determine the precise cause of exclusion of each tissue from transplantation.
All the tissues offered to our eye bank were accepted unless the donor is known to have potentially transmittable diseases that would place the enucleator at risk (i.e., AIDS, Jakob-Creutzfeldt, etc.). Eyeballs from the donors with positive ocular or medical history or positive serology for any of human immunodeficiency virus, hepatitis B virus, hepatitis C virus or syphilis were excluded from transplantation. All received eyeballs underwent thorough slit-lamp examination. If the cornea was without any obvious pathology, the corneoscleral rim was excised; preserved and specular microscopic evaluation was performed.
Cornea with specular count ≥2000 cells/mm² is utilized for optical transplantations. There is no donor age or specular count cutoffs for using cornea for therapeutic transplantations. Eyeballs with positive serology are discarded and eyeballs not utilized clinically because of donor's past medical history or poor quality (endothelial guttata/striae, low endothelial count, arcus senilis, epithelial defects, stromal edema, collapsed anterior chamber, corneal scar/infiltrate) are utilized for training or research purpose depending on the requirement.
| Results|| |
A total of 413, 454, 430, and 412 corneas were retrieved in the years 2012, 2013, 2014, and 2015, respectively. Percentage of male donors was 62.47%, 53.42%, 62.9%, and 59.11% in the years 2012, 2013, 2014, and 2015, respectively. In each year, more than half of the corneas were retrieved from donors more than 70 years of age, maximum being 58.28% in the year 2013 [Graph 1]. In each year, approximately, half of the eyes retrieved were pseudophakic, maximum being 55% in the year 2013 [Graph 2]. Clinical utilization of the tissue was more for phakic eyes as compared to pseudophakic eyes [Table 1]a and [Table 1]b and was decreasing with increasing donor age [Table 2]a and [Table 2]b. Clinical utilization of the tissues received was least (33.30%) in the year 2013, in which donors with more than 70 years and pseudophakic eyes were maximum [Graph 3]. Most common cause of excluding tissue from transplantation was poor quality of cornea followed by donor's medical history [Table 3].
|Table 1a: Eyes utilized for Optical, Therapeutic and Training/Research purpose from Phakic and Pseudophakic group|
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|Table 1b: Eyes utilized for Optical, Therapeutic and Training/Research purpose from Phakic and Pseudophakic group|
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|Table 2a: Utilization of cornea for Optical (O), Therapeutic (T) and Training/Research purpose (T/R) in different age groups|
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|Table 2b: Utilization of cornea for Optical (O), Therapeutic (T) and Training/Research purpose (T/R) in different age groups|
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| Discussion|| |
Long-term success of the corneal transplant procedure is highly dependent on the quality of the tissue utilized. With the current situation of a wide gap between demand and supply of the corneal tissue, getting better quality tissues is even a bigger challenge. A quality of tissue received by any eye bank is dependent on the demographics and level of awareness regarding eye donation among the population which it is covering. With the increasing life expectancy and trend of relatively early cataract extraction in urban population, number of elderly and pseudophakic donors is increasing.
In our study, from the year 2012 to the year 2015, each year, more than 50% of tissues were from donors more than 70 years of age, and around 50% of tissues were pseudophakic. As there is no clear donor age cutoff and pseudophakic donor tissue is not a contraindication for the clinical use, all the tissues fulfilling the criteria for clinical use were utilized for optical or therapeutic transplantations. However, optical grade tissues in elderly and pseudophakic groups were much less as compared to tissues from a young and phakic group, resulting in relatively lower utility rates of the corneas in our study.
In our study, corneal utility rate from the donors more than 70 years of age was 27.6%. Several eye banks have reported lower rate of corneal utilization with advanced donor age: Moyes et al. reported a 23% rate in donors aged 70–75 years, Armitage and Easty reported a 45% rate in donors 80 years and over, and Gain et al. reported a 53% rate in donors 85–100 years. New Zealand National Eye Bank study reported 80% corneal utility rate from donors aged 80–85. Exclusion of donors who did not met the donation criteria by thorough prescreening of the potential donor can be the reason for higher tissue utility rate in their study.
Rajan et al. have evaluated donor and tissue profile of a community eye bank in Eastern India. In their study, mean age of donors was 52 ± 21 years, and the majority of the donors were between 41 and 50 years age group. The majority of donors were motivated (86%) under hospital cornea retrieval program (HCRP), and remaining (14%) were voluntary. Corneal tissue utilization rate was 75%. In contrast to their study, all eyes received by our eye bank were through voluntary donation. Higher utility rate in their study can be attributed to relatively younger donor age and exclusion of harvesting tissues which are contraindicated to use with the help of HCRP.
Studies have demonstrated an important role of HCRP in eye banking scenario in India. HCRP has several inherent advantages such as more number of deaths in hospital in comparison to home deaths, availability of good quality and younger tissues with less death to preservation interval. As complete medical history and investigations of the donor are available, tissues which are contraindicated for transplantation can be excluded from the harvesting. This significantly reduces a burden on financial and workforce resources. For effective functioning of HCRP, round the clock availability of the trained eye donation counsellor, social worker or well-versed and motivated hospital staff is mandatory.,
A retrospective study was conducted by Kumar et al. to identify the number of potential donors from trauma-related deaths and examine the extent of loss of opportunity to approach the families of the eligible donors. Among eligible donors, 78% (n = 831) were lost opportunity cases. Among 235 families approached, only 8.5% (n = 20) agreed to eye donation. Overall, successful eye donation was possible in only 1.9% (n = 20) of the eligible trauma-related deaths. They suggested that efforts are needed to augment existing administrative and workforce resources to increase the corneal procurement rate from trauma-related deaths in India.
Worldwide, there is a procedural shift from full thickness corneal transplant to anterior and posterior lamellar transplants. Gogia et al. reviewed the changing pattern of corneal utilization in an eye bank at a tertiary care center in North India. They found the percentage of donor corneal utilization increased significantly over time with the rate being 65.08%, 70.06%, and 68.29%, respectively, in the years 2003, 2008, and 2011; however, this change was reflected only in the usage of nonoptical grade corneas for therapeutic transplantations and anterior lamellar transplantations and not for the optical grade corneas. That indicated, though tissue procurement has increased over the years, the quality of the tissue remains average. They observed increase in lamellar corneal procedures over years, but this increase was not reflected in the usage of nonoptical grade corneas. They also did not observe any significant increase in the incidence of usage of a single donor cornea for multiple recipients.
In their study, families of donors, who do not meet tissue safety eligibility criteria, are informed that in the event of unsuitability for keratoplasty, tissue might be used for medical education and research. The families are given the option of withdrawing their decision to donate. With the introduction of this protocol, harvesting of cornea not suitable for use has declined considerably. Our eye bank is not following this protocol as this information can have a negative impact on the motivation of the mass population regarding eye donation.
In our study period, out of all tissues we received, 54% of tissues were retrieved from donors more than 70 years and 49.5% of tissues were pseudophakic. The corneal utility rate in study duration was 42%. Most common cause of clinical nonutility of the tissue was poor quality (37.3%) followed by a medical history of the donor (15.4%) and safety reasons (2%).
| Conclusion|| |
Lesser availability of good quality younger and phakic eyes lead to relatively lower corneal tissue utility rate in our study. Procurement of more number of pseudophakic eyes can be attributed to the trend of relatively early cataract extraction in the urban population covered by our eye bank. Most of the eyes we received were from the voluntary donation, suggesting the high level of awareness regarding eye donation in general population of our city. However, availability of optical grade corneas was less due to more number of elderly and pseudophakic donors. Eye donation awareness programs targeting multispecialty hospitals or trauma centers can be more rewarding to receive more number of optical grade corneas.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]