Corneal Tissue Donations Dwindled Due to Pandemic, Eye Banks Update Guidelines  

Corneal tissue donations and transplantation procedure rates dropped dramatically due to the COVID-19 pandemic, but eye banks are updating their guidelines to be more prepared for future interruptions, according to a review article published in Frontiers in Medicine. The research shows that the protective measures taken at the height of the pandemic also led to geographical challenges that resulted in patients traveling greater distances to obtain care.

Researchers explored international data from the PubMed database, using keywords and search terms “corneal transplantation,” “eye banks,” and “keratoplasty” combined with searches for “COVID-19.” Relevant articles through September 2022 were assessed and 25 articles were included. 

The review shows that all the eye banks included contraindicated corneal tissue donations from patients whose confirmed cause of death was COVID-19, and that several discarded donations from patients who had COVID-19 at the time of death, but died of other causes or those who had recovered from a COVID-19 infection and then passed away from other causes later on. Eye banks that did accept donations from COVID-19 positive donors required a range of symptom-free periods before death, from 14 days in the least stringent cases, to 28 days in the most stringent cases. Some centers also rejected donations from any donors who demonstrated any unexplained symptoms of cough, asthenia, myalgia, intermittent fever, shortness of breath or conjunctivitis before death.

While these safety measures decreased the availability of corneal tissue donations, a relative international decrease in the number of corneal transplant procedures also occurred, according to the report.

Elective corneal transplants dropped significantly in many cases, the review shows. According to research from the Italian Society of Eye Banks, procedures there dropped from 1220 operations in March and April 2019 to 534 in March and April 2020, a 56% drop. The Eye Bank of Canada Ontario Division noted an even greater decline (73%) from March through June 2019 (753 procedures) to the same period in 2019 (207 procedures). London’s Mooresfield Eye Hospital noted a 92% decrease in corneal transplants from 163 from April through June, 2019, to 10 from April to June, 2020. 

Conversely, at least 1 reviewed study shows an increase in the need for emergency corneal procedures, as an increase in domestic violence during the lockdowns are suspected to have increased the number of emergency department visits for sharp object trauma. 

The overall declining rates of surgery during the lockdown period, however, have imparted some lessons on eye banks. The surplus of corneal tissue amassed during the lockdown period due to the reduction in scheduled surgeries and rise cancellations led some study authors to evaluate alternative procurement techniques in the hopes of extending storage times of procured corneal tissues. Dehydrated tissue also proved to be a useful alternative during this time, especially for patients undergoing deep anterior lamellar keratoplasties. 

“A survey of eye banks and surgeons in India showed a statistically significant increase in the use of long-term tissue preservation methods in the same period in 2020 compared to previous years,” the researchers report. 

Although eye banks are now reporting an increase in the number of corneal transplant procedures being performed, they are still not up to pre-pandemic rates.