Corneal tissue from elderly donors: a commentary

Drs Aravind Roy and Sujata Das, Cornea and Anterior segment service, L V Prasad Eye Institute comment on the underutilization of elderly corneal tissues despite better utilization data, improvements in feasibility due to lamellar keratoplasty, and emergency-use reliability of glycerol-preserved corneal tissue for tectonic keratoplasty. 

For decades, corneal surgeons have been conservative in utilizing donor corneas from the elderly.  They believed that poorer endothelial count along with other ageing characteristics of the corneal tissue like arcus or pseudophakia would have a higher risk of graft failure. The dominance of penetrating keratoplasty, with nearly a century of collective experience, also played a role.

A controlled clinical trial by the Cornea Donor Study (CDS) investigator group overturned these 'myths' about elderly corneas. The trial showed that there was no difference in five-year graft survival rates for corneal transplants between those younger or older than 66 years. A recent retrospective study looked at 1,217 eyes and examined the utilization of corneas from those over 75 years. It found that one-third of those corneas could be utilized, especially if the donors were phakic and had high endothelial cell density (ECD).

A commentary on this retrospective study, in the Indian Journal of Ophthalmology, addresses these findings and underscores the many developments in our understanding of corneal grafts based on elderly corneas. The authors discuss the impact of lamellar keratoplasty, which has reduced the significance of tissue quality alone as a determinant for utilization of donor corneas. They also note their own experience using glycerol-preserved corneas during India’s COVID19 lockdown for tectonic keratoplasty. This concatenation of evidence, the authors write, should help corneal surgeons shed their conservative approach to elderly corneas. 

'There is an inherent reluctance of accepting corneal tissues from elderly donors aged 65 years and above due to a fear of potential poor chance of graft survival,' says Dr Aravind Roy, Consultant, Cornea and Anterior Segment, KVC Campus, L V Prasad Eye Institute. 'However, several well-conducted studies have found acceptable outcomes after transplantation of corneal tissue from donors of this age group that has matched the outcomes from younger tissues.'

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Roy, Aravind; Das, Sujata1, Commentary: Utilization rate of corneal tissue obtained from donors over 75 years of age in Western India for keratoplasty, Indian Journal of Ophthalmology: February 2022 - Volume 70 - Issue 2 - p 516
doi: 10.4103/ijo.IJO_2553_21

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