In situ cornea harvesting through the Red Cross Organization:a new approach to relieving severe cornea donor shortage in Chinese eye banks

Corneal diseases are currently the second main cause of blindness in China.Although most of the corneal blindness could be treated by corneal transplantation,only about 10 000 operations were carried out each year owing to the severe shortage of corneal donors and limited eye bank programs.A feasible cornea donation program was established through the organization of the Red Cross,and in situ corneal removal techniques were developed to avoid conflicts with Chinese traditions of keeping the deceased intact.The number of donated corneas,which had a safe and secure quality,increased significantly year by year.

Association between donor corneal endothelial cell counts and infectious agent reactivity:an eye bank database analysis

Background:To evaluate the association between corneal central endothelial cell count(CECC)with reactivity for hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV),human T-lymphotropic virus-1(HTLV1),and syphilis from an eye bank database.Methods:Eye bank data included 19,159 donors and 38,318 corneas screened for HBV,HCV,HIV,HTLV1,and syphilis from July 2007-May 2015.Linear and binary mixed effects models were used to determine the adjusted marginal effect a positive viral screening test had on CECC and morphology,respectively.The models were adjusted for age,race,gender,lens status,and death to preservation.Eyes with missing data were excluded from the analysis.Statistical significance was defined as P values<0.05.Results:A total of 18,097 donors and 35,136 corneas were included in the final analysis.Average CECC for eyes with negative viral screening was 2,597±436 while the average CECC for eyes screening positive for syphilis,HBV,HCV,HIV,and HTLV1 were 2,638±392(P=0.073),2,569±419(P=0.815),2,603±363(P=0.207),2,615±360(P=0.733),and 2,625±436(P=0.362)respectively.Conclusions:The presence of HBV,HCV,HIV,HTLV1,and syphilis display no association with a statistically significant difference in CECC when compared to normal non-diseased donors.

Awareness of Cornea Donation of Registered Tissue Donors in Nanjing

Objective To evaluate the current cornea donation awareness of tissue donors in the city of Nanjing, China Methods Altogether 2000 registered tissue donors in the Red Cross Eye Bank of Nanjing by the end of 2010 and 2000 control residents of Nanjing in February to June 2011 were randomly selected to par- ticipate in our field questionnaire survey. The questionnaire consisted of questions regarding the understand- ing of cornea donation, the attitude toward cornea donation, and attitude toward legislation and free dona- tion. The awareness of cornea donation between the registered tissue donors and residents was compared. Related factors of the willingness to donate corneas and to become a tissue donor were evaluated with uni- variate and multiple logistic regression analysis. Results A total of 1867 （response rate： 93.4%） tissue donors and 1796 （response rate： 89.8%; ef- fective questionnaires： 1697） residents participated in this survey. For the questions about the knowledge of cornea donation, 90.3% tissue donors （residents： 78.9%） knew that donated corneas could be used for transplantations; 71.2% tissue donors （residents： 47.6%） knew that the appearance would not be destroyed after cornea donation; 70.7% tissue donors （residents： 20.0%） knew the formalities to become a cornea do- nor. For attitude toward cornea donation, 82.2% tissue donors （residents： 45.1%） were willing to donate corneas or eyeballs after death; 84.0% tissue donors （residents： 30.2%） had discussed with their families about donation; 85.1% tissue donors （residents： 24.8%） supported their families＇ or friends＇ cornea donation For attitude toward legislation and free donation, 88.3% tissue donors （residents： 61.3%） approved of legis- lation to regular cornea donation; 72.2% tissue donors （residents： 38.8%） thought that cornea or organ do- nation should be gratis. The difference between two groups was significant （P〈0.001）. However, some tissue donors did not know cornea donation well, some even opposed the legislation of cornea donation and free donation protocol. For the factors influencing the willingness to donate corneas, population was the mostrelevant factor （P〈0.O01）, since tissue donors were more willing to donate corneas than residents. Other significantly related factor were age, gender, occupation, and education level （P〈0.001 ）, while political status or religion were not significant. For the factors related to becoming a tissue donor, older age, male, white-collars （including white-collar, civil servant, teacher, soldier, lawyer, salesman, healthcare provider）, higher education level, party members （including the Chinese Communist Party members, democratic party members, and the CommunistYouth League members） （P〈0.05）. Conclusions The registered tissue donors have better understanding and more positive attitude to- wards cornea donation than control residents do. They approve of the legislation of cornea donation and free donation protocol. It may be more effective to target the population of over 58 years old, male, white-collars, well-educated people, and party members in the promotion of cornea donation.

Clinical application of a shape-preserving rapid corneal donor dehydrater

AIM:To describe the design and clinical application of a corneal donor dehydrator which can quickly dehydrate corneas and keep its original shape.METHODS:The corneal donor material is placed on stainless steel beads with different diameters in the dehydrating box to make the cornea the same shape as the steel ball.Then,the cornea is placed inside the dehydrater for rapid dehydrating using the internal cleaning and ventilation system.Totally 83 eyes underwent deep anterior lamellar keratoplasty(DALK)using corneal donor tissue preserved with corneal dehydrater,and 60 patients(60 eyes)received DALK by the same surgeon using corneal donor tissue preserved with glycerol were included in the control group.The best corrected visual acuity(BCVA),the thickness and transparency of the corneal buttons were recorded.RESULTS:After the completion of dehydrating,all the donor corneas maintained a normal shape without any shrinkage or distortion,and the average intraoperative rehydration time was 43.3±12.1 s during operation.The mean BCVA of the dehydrater group was 0.30±0.18 at 1 wk and 0.32±0.16 at 1 mo,which were statistically better than that of the control group(P<0.001).The score of corneal buttons transparency were lower than that of the control group with statistical difference(P<0.001).The thickness of corneal buttons at 1 wk and at 1 mo in the dehydrater group was significantly better than that of the control group respectively(P<0.001).One week after operation,no corneal button turbidity or edema was observed in both groups.CONCLUSION:The dehydrater can quickly dehydrate the corneal material in a clean and airtight environment and maintain the original shape of the corneal donor during the dehydrating process.This dehydrater is recommended for long-term high-quality preservation in areas where corneal materials cannot be used within a reasonable time period.

Corneal blindness and current major treatment concerngraft scarcity

According to World Health Organization, the global prevalence of blindness in 2010 was 39 million people, among which 4% were due to corneal opacities. Often, the sole resort for visual restoration of patients with damaged corneas is corneal transplantation. However, despite rapid developments of surgical techniques, instrumentations and immunosuppressive agents, corneal blindness remains a prevalent global health issue. This is largely due to the scarcity of good quality corneal grafts. In this review, the causes of corneal blindness, its major treatment options, and the major contributory factors of corneal graft scarcity with potential solutions are discussed.

Age related macular degeneration: from evidence based-care to experimental models

To describe the current aging population in China and globally,especially as it applies to age-related macular degeneration(AMD).To review the current standards of care for treating both wet(exudative)eAMD and dry(atrophic)aAMD.And to introduce a model for experimentation that is based on the Age-Related Eye Disease Study(AREDS)using eye bank tissue.A literature search that outlines current aging populations,standards of clinical treatment as defined by large,multicenter,randomized clinical trials that present level-I data with a low risk for bias.An experimental model system of AMD is presented that enables scientific analysis of AMD pathogenesis by applying grading criteria from the AREDS to human eye bank eyes.Analysis includes proteomic,cellular,and functional genomics.The standard of care for the treatment of eAMD is currently defined by the use of several anti-vascular endothelial growth(anti-VEGF)agents alone or in combination with photodynamic therapy.Monotherapy treatment intervals may be monthly,as needed,or by using a treat-and-extend(TAE)protocol.There are no proven therapies for aAMD.AMD that is phenotypically defined at AREDS level 3,should be managed with the use of anti-oxidant vitamins,lutein/zeaxanthin and zinc(AREDS-2 formulation).By understanding the multiple etiologies in the pathogenesis of AMD(i.e.,oxidative stress,inflammation,and genetics),the use of human eye bank tissues graded according to the Minnesota Grading System(MGS)will enable future insights into the pathogenesis of AMD.Initial AMD management is with lifestyle modification such as avoiding smoking,eating a healthy diet and using appropriate vitamin supplements(AREDS-2).For eAMD,anti-VEGF therapies using either pro re nata(PRN)or TAE protocols are recommended,with photodynamic therapy in appropriate cases.New cellular information will direct future,potential therapies and these will originate from experimental models,such as the proposed eye bank model using the MGS,that leverages the prospective AREDS database.