Abstract
Donated corneas are classified as tectonic if there are defects within any layers of the cornea which would prevent a satisfactory visual outcome after transplantation. This study aimed to evaluate whether some tectonic corneas have sufficient endothelial characteristics to allow their use in posterior lamellar keratoplasty, and explored their reclassification for use in this sight-improving procedure. A retrospective review of all corneal tissues preserved by the Sorocaba Eye Bank from January to April of 2014 was performed. All donated corneas classified as tectonic were included. Endothelial tissue was defined as healthy and viable for posterior lamellar keratoplasty if endothelial cell density was ≥2000 cells/mm2. Additional parameters analyzed included Descemet folds and stretch marks, loss of endothelial cells, corneal endothelial polymegathism/ pleomorphism, pseudo-guttata, and reflectivity. During the study period, 2,847 corneas were preserved, of which 423 (14.85%) were classified as tectonic. Of these, 87 (20.56%) were reported as having endothelial viability and were included in the posterior lamellar keratoplasty group. Average corneal endothelial cell density of this group was 2,471 SD ± 256 cells/mm2 (range 2012-2967 cells/mm2). A significant number of corneas classified as tectonic showed endothelial viability and were included in the posterior lamellar keratoplasty group (20.56%). Despite stromal and/or epithelial alterations, these corneas could have been potentially distributed for posterior lamellar transplantation to improve vision, thus reducing the corneal transplantation waiting period. This study highlights how corneal tissue reclassification could increase the potential amount of corneal tissue available for optical transplantation.
Highlights
Corneal transplantation is reported to be the most frequent type of transplant performed around the world[1,2]
This study aimed to evaluate whether some tectonic corneas have sufficient endothelial characteristics to allow their use in posterior lamellar keratoplasty, and explored their reclassification for use in this sight-improving procedure
Corneal transplantation is a viable option for visual rehabilitation in those who are blind se condary to corneal diseases[22]
Summary
Corneal transplantation is reported to be the most frequent type of transplant performed around the world[1,2]. In Brazil alone, there has been a reported increase in corneal transplants from 3,626 procedures in 2000 to 14,534 cases in 2016(3,4). Optical keratoplasties are the most prevalent, followed by tectonic and therapeutic[6]. In Brazil, donated corneas are often classified as optical or tectonic. They are defined as optical if all the corneal layers are viable and if they can be used to perform penetrating corneal transplantation to improve visual acuity. Donated corneas are defined as tectonic if there are defects within any corneal layers which would prevent a satisfactory visual outcome[5,7]
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