Impact of COVID-19 pandemic on patients with corneal transplant

Examining the Influence of COVID-19 Infection and Pandemic Restrictions on the Risk of Corneal Transplant Rejection or Failure: A Multicenter Study

PURPOSE

The purpose of this study was to evaluate two aims. The first was whether patients with a history of keratoplasty who developed COVID-19 were at a higher risk of corneal graft rejection or failure. The second was examining whether patients who underwent a new keratoplasty during the first 2 years of the pandemic from 2020-2022 were at a higher risk of the same outcomes compared to those undergoing keratoplasty from 2017-2019 before the pandemic.

METHODS

A multicenter research network, TriNetX, was used to query for keratoplasty patients with or without a COVID-19 between January 2020 and July 2022. Additionally, the database was also queried to identify new keratoplasties performed from January 2020-July 2022 and compare it to keratoplasties performed during a similar pre-pandemic interval between 2017-2019. 1:1 Propensity Score Matching was utilized to adjust for confounders. Graft complication of either a rejection or failure was assessed within 120 day follow-up using the Cox proportional hazard model and survival analysis.

RESULTS

A total of 21,991 patients with any keratoplasty history were identified from January 2020-July 2022, of which 8.8% were diagnosed with COVID-19. Matching revealed two balanced cohorts of 1,927 patients where no significant difference in risk of corneal graft rejection or failure among groups ((aHR [95% CI] = 0.76 [0.43,1.34]; p = .244)). Comparing first-time keratoplasties performed in a pandemic period of January 2020-July 2022 to a corresponding pre-pandemic interval from 2017-2019 also similarly revealed no differences in graft rejection or failure in matched analysis (aHR = 0.937[0.75, 1.17], p = .339).

CONCLUSIONS

This study found no significant increase in the risk of graft rejection or failure in patients with a prior keratoplasty history following COVID-19 diagnosis nor in any patients who had a new keratoplasty done during 2020-2022 when compared to a similar pre-pandemic interval.

An Overview of Corneal Transplantation in the Past Decade

The cornea is a transparent avascular structure located in the front of the eye that refracts light entering the eyes and also serves as a barrier between the outside world and the internal contents of the eye. Like every other body part, the cornea may suffer insult from trauma, infection, and inflammation. In the case of trauma, a prior infection that left a scar, or conditions such as keratoconus that warrant the removal of all or part of the cornea (keratoplasty), it is important to use healthy donor corneal tissues and cells that can replace the damaged cornea. The types of cornea transplant techniques employed currently include: penetrating keratoplasty, endothelial keratoplasty (EK), and artificial cornea transplant. Postoperative failure acutely or after years can result after a cornea transplant and may require a repeat transplant. This minireview briefly examines the various types of corneal transplant methodologies, indications, contraindications, presurgical protocols, sources of cornea transplant material, wound healing after surgery complications, co-morbidities, and the effect of COVID-19 in corneal transplant surgery.

Eye banking and keratoplasty trend analysis during the COVID-19 pandemic: A South Indian observational study

Purpose

To analyze the impact on eye donation and corneal transplantation during the COVID-19 pandemic in a tertiary eye hospital in south India.

Methods

A retrospective analysis of the donor and recipient records during the study period from January 2020 to May 2021 was conducted and tabulated in Microsoft Excel 2013. Demographic details of the donor, utility rate, cause of death, culture characteristics, storage methods, wet lab usage, and the surgical donor outcomes were evaluated. Additionally, the postoperative workup of the recipients, diagnosis, graft infection and rejection episodes, development of COVID-19 postoperatively, and outcome in terms of visual acuity at one, three, and six months were also noted.

Results

A total of 466 eyes from 249 donors were received during the study period. The mean age of the donor population was 62.43 years (20.9). The corneal transplantation utility rate was 36.4% (n = 170). Fifty-one percent of the total transplant surgeries were for therapeutic purposes. This was followed by penetrating optical keratoplasty (34%), Descemet's stripping endothelial keratoplasty (9%), and patch grafts (3%). Seventeen (10%) graft rejection episodes were noted and nine (53%) had complete resolution after medical treatment.

Conclusion

Proper preventive measures are key to carrying out safe and efficient eye banking activities even during a deadly pandemic, as COVID-19 transmission via transplantation is rare.

Effect of Covid-19 on Eye Banks and Corneal Transplantations: Current Perspectives

The coronavirus disease 2019 (COVID-19) pandemic exerted a great impact on medical practice, which was reframed according to the actual needs. Ophthalmological services and procedures including corneal transplantation did not represent an exception. The adoption and implementation of new standard operating procedures as well as of new technologies for remote consultation and smart-working reshaped daily activities of both eye bankers, physicians, researchers, and patients. Regulatory restrictions were issued redefining corneal donor eligibility criteria, as well as handling and harvesting procedures of donor ocular tissues. Surgical schedules underwent an abrupt contraction with prioritization of urgent procedures. Local lockdowns and confinement strategies resulted in both a reduction and redirection of research activities. The evaluation of SARS-CoV-2 colonization of ocular tissues, long-term corneal storage techniques, new disinfection strategies, split corneal transplants and cell-based therapies for the treatment of corneal disease peaked in the pipeline. Aim of this article is to summarizes the overall impact of the pandemic on the corneal transplantation machinery, and the current and future perspectives for the corneal transplant community.

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.