COVID-19 positivity rate in corneal tissue donors - A cause for concern!

SARS-CoV-2 infection status in corneal preservation solution and COVID-19 prevalence after corneal transplantation

The potential risks associated with organs from COVID-19-infected donors were unclear. To determine the SARS-CoV-2 infection status of corneas transplanted during the COVID-19 pandemic, we performed a polymerase chain reaction (PCR) using the corneal preservation solution that was used for corneal transplantation. We also examined the postoperative health status of the recipients. This study included 144 transplants in 143 eyes. Ninety-nine eyes of imported corneas and 10 of the 14 corneas donated in the prefecture were PCR tested at our hospital, and all were SARS-CoV-2 negative. All corneal transplants were performed after confirming their SARS-CoV-2 negativity by a PCR using a corneal preservation solution at our hospital or a nasopharyngeal swab at a previous facility. Despite postoperative steroid administration, no patient developed COVID-19 infection until discharge. Hence, if the donor's nasopharyngeal swab test is SARS-CoV-2 negative, COVID-19 infection in the recipient due to corneal transplantation may be prevented. Since corneal transplant recipients are susceptible to infection due to prolonged steroid administration and are at high risk for severe diseases if infection occurs, SARS-CoV-2 detection testing using nasopharyngeal swabs in donors should be performed.

A Review of Corneal Transplantation: An Insight on the Overall Global Post-COVID-19 Impact

The coronavirus disease 2019 (COVID-19) pandemic made us reframe a lot of the strategies followed in medical practice and ophthalmological services and procedures were also not spared, including corneal transplantation or keratoplasty, the most routine procedure performed worldwide. The prevalence of viral presence in the ocular tissue necessitates a focus on the handling of donor ocular tissue and the functioning of eye banks, ensuring it doesn't risk the patient and the doctor's safety. Restrictions in the movement of people during the pandemic limited the number of donations, causing a shortage of tissues, with a large number of people already waitlisted for tissue needs. The lesson from the COVID-19 pandemic directs us to look for long-term corneal storage techniques taking into consideration the tissue viability time and the possibility of post-pandemic shortages. Although there is not a significant number of reports, the cases of corneal graft rejection post-vaccination against COVID-19 are highlighted and thus should form a part of the lookout while evaluating the possible cause of rejection of grafts. This article summarises the overall impact of the pandemic on corneal transplantation and the possible future of storage techniques, which need to evolve and be adapted.

Immediate impact of COVID-19 on eye banking in India

Purpose

In India, COVID-19 infected more than 10 million and caused more than 148,000 fatalities during 2020. Due to "lockdown" eye banks were shuttered in March, 2020 and reopened for operations in the month of May, 2020. This study assesses the immediate impact of the pandemic on eye banking and cornea transplantation in India.

Methods

Data was gathered through an online survey of the eye banks and cornea surgeons in India. The questionnaire collected information on the vital statistics of eye bank operations and cornea transplants for the period from March to June for the years 2019 and 2020.

Results

47 eye banks responded to the survey. Collectively in the March-May 2020 period, corneas collected and transplanted declined by 78.27% and 79.14%, respectively, compared to the same period of 2019. In June 2020, the first full month after operations restarted, the collection and transplants were respectively, 82.10% and 81.82%, lower than June, 2019. Long-term glycerine preservation of corneas in the period from March to June 2020 increased by 124.5% compared to same period in 2019, but overall only 5.26% of the corneas recovered were preserved in this way. 44.44% of the eye banks collected corneas only from donors with negative COVID-19 diagnosis. 36.11% of the respondents rejected all suspicious cases, such as donors with respiratory pathologies, and 2.78% of the respondents accepted donations from medico legal cases only. 19.44% of the responding eye banks did SARS-CoV-2 nasal swab test for the deceased donor. 79.5% of the eye banks reported that staff were willing to work during the pandemic, and 82.05% eye banks gave special training to staff before restarting services.

Conclusion

Due to the steep decline in collections and transplants, 2020 can be termed as a lost year in Indian eye banking. Attention to Hospital Cornea Recovery Programs, continuous situation monitoring, and ongoing staff training programs are recommended.