HYDERABAD, India — Corneal tissue precut by an eye bank provides better safety and quality assurance despite some disadvantages, according to a speaker here.
“Precut tissue entails higher costs, needs swelling and a time interval of over 24 hours before transplantation. On the other hand, it is thoroughly examined and analyzed by slit lamp and specular microscopy. Only the best and safest lenticules are used in the OR,” Howard Cajucom-Uy, MD, said at the joint meeting of the Asia-Pacific Academy of Ophthalmology and All India Ophthalmological Society.
U.S. eye banks started precutting corneas in 2006, and the precut tissue eventually received widespread acceptance by surgeons as data were published. In Asia, precutting began in 2011.
“In the Singapore eye bank, over 6 months in 2011, a service for precutting was set up and personnel trained. In the following 15 months, 140 corneas were precut, 137 successfully. Transplant rate was 94%,” Cajucom-Uy said.
Data on precut grafts were analyzed and compared to surgeon-cut grafts. Precut grafts were found to be thinner on average and to have a slightly higher cell loss. According to Cajucom-Uy, this may be due to blade vibration as well as a variety of operator-, surgeon- and patient-related factors.
He recommended using ophthalmic viscosurgical devices for better endothelial protection and exercising caution when cutting floppy corneas and corneas from young donors or those with phaco incisions.
“After cutting, allow the corneal endothelium to stabilize before performing specular microscopy. Document relevant data including deviation from standard operating procedures,” Cajucom-Uy said.
Future developments may include ultra-thin cutting systems, femtosecond laser refinement for customized-thickness posterior grafts, and the preparation of preloaded precut lenticules, he said.
Disclosure: Cajucom-Uy has no relevant financial disclosures.