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Corneal Physician

Article

Covering COVID-19’s Impact on Eye Banking

A look at how the pandemic has affected global supply and demand

By: SHAHZAD MIAN, MD
Corneal Physician April 1, 2023 Vol 27, Issue April 2023 Page(s): 30, 31

The COVID-19 pandemic affected essentially all aspects of health care, including transplantation guidelines and procedures. It has been documented that the COVID-19 pandemic hampered both the supply and demand of corneal tissue.1 (See “COVID-19’s Transmission and Presence in Ocular Tissues”.) The reasons cited include logistical issues (e.g., tissue recovery, staff safety, and limited access to hospitals), the temporary closure of eye banks themselves, and COVID-19–caused guidelines created by eye banks to decrease potential donor-recipient transmission of the disease.1

This article discusses the impact of the shortages, and the status of eye banking now.

Impact of COVID-19

At one eye bank, between March and June 2020, when there was a pause of elective surgeries due to COVID-19’s wrath, there continued to be a surplus of corneal tissue.2

However, over the next year and a half when demand for corneal tissue returned to baseline, there was a shortage of corneal tissue that required increased tissue imports from other eye banks.3 This shortage of corneal tissue when corneal transplantation procedures were restarted was demonstrated across the globe.

A U.S. eye bank had a 4.30% shortage of suitable corneas compared with transplantation procedures.3 This void was filled by importing corneal tissue from other eye banks.

COVID-19 forced eye banks to shutter their doors at the beginning of the COVID-19 pandemic. This was the case with other health care and business entities as well. IMAGE COURTESY STOCK.ADOBE.COM / PHONLAMAIPHOTO
COVID-19 forced eye banks to shutter their doors at the beginning of the COVID-19 pandemic. This was the case with other health care and business entities as well. IMAGE COURTESY STOCK.ADOBE.COM / PHONLAMAIPHOTO

As surgery volumes returned to normal in Canada, The Eye Bank of Canada needed to import corneas from the United States to meet demand.4 In Brazil, the national waiting list for keratoplasty significantly increased because of the pandemic.5 The year prior to the start of the pandemic, U.S. eye banks exported 28,000 donor corneas to be transplanted internationally.6

Status Now

Elective corneal transplantation procedures are back to normal pre-COVID-19 volume in the United States.

Additionally, there have been no reports of donor-recipient transmission of the disease. Further, there have been at least 9 reports of corneal transplantation using tissue from a COVID-19–infected donor with no reported adverse effects.7 CP

COVID-19 TRANSMISSION AND PRESENCE IN OCULAR TISSUES

SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) receptors on human cells to gain entry intracellularly. ACE2 receptors have been localized to the aqueous humor,8 retina,9 conjunctiva, and cornea.10 SARS-CoV-2 has been detected in the tears of COVID-19 patients,11-15 and can result in conjunctivitis in 1% to 3% of patients.11,16,17 These findings highlighted the possibility of infectious SARS-CoV-2 particles in the corneas of infected patients, which could have the potential to transmit infection through tissue donation.

The SARS-CoV-2 antigen has been isolated intracellularly within the ocular tissues of an alive, previously infected-living patient.18 However, there are conflicting reports of the presence of viral particles within post-mortem ocular tissue. One study revealed SARS-CoV-2 in post-mortem conjunctival and vitreal samples.19 While some studies showed no detectable levels of SARS-CoV-2 RNA within post-mortem ocular tissues of infected patients,20,21 others were able to isolate nucleic material in the corneas of deceased SARS-CoV-2–positive individuals.22-24 That said, one study revealed that SARS-CoV-2 does not infect and replicate within corneal explants, thereby potentially reducing risk of infectivity.25 Additionally, a theoretical model created using Canadian COVID-19 data showed that it would take 16 years at peak infection of the first wave of the pandemic to observe one transmission.26

References

  1. Aiello F, Afflito GG, Pocobelli G, Ponzin D, Nucci C. Effect of Covid-19 on Eye Banks and Corneal Transplantations: Current Perspectives. Clin Ophthalmol. 2022 Dec 30;16:4345-4354.
  2. Ballouz D, Sawant OB, Hurlbert S, et al. Impact of the COVID-19 pandemic on keratoplasty and corneal eye banking. Cornea. 2021;40(8):1018-1023.
  3. Ballouz D, Issa R, Sawant OB, et al. COVID-19 and eye banking: ongoing impacts of the pandemic. Cornea. 2023;42(1):89-96.
  4. AlShaker SM, Humphreys C, Smigielski N, Chan CC. The effect of COVID-19 on corneal donor volumes and eye bank processes: an analysis from the Eye Bank of Canada (Ontario Division). Cornea. 2022;41(6):757-765.
  5. Moriyama AS, Erbs Pessoa JL, Silva Bessa TR, et al. The impact of the COVID-19 pandemic on corneal transplantation in Brazil. Cornea. 2022;41(3):322-327.
  6. Eye Bank Assocation of America. 2019 Eye Banking Statistical Report. Washington, DC; 2020.
  7. Aldave AJ, DeMatteo J, Chamberlain WD, et al. COVID and the cornea: from controversies to consensus: report of the Eye Bank Association of America Medical Advisory Board policy and position review subcommittee. Cornea. 2021;40(7):809-816.
  8. Holappa M, Vapaatalo H, Vaajanen A. Many faces of renin-angiotensin system-focus on eye. Open Ophthalmol J. 2017;11(1):122-142.
  9. Senanayake PDS, Drazba J, Shadrach K, et al. Angiotensin II and its receptor subtypes in the human retina. Investig Ophthalmol Vis Sci. 2007;48(7):3301-3311.
  10. Sun Y, Liu L, Pan X, Jing M. Mechanism of the action between the SARS-CoVS 240 protein and the ACE2 receptor in eyes. Int J Ophthalmol. 2006;6(4):783-786.
  11. Zhang X, Chen X, Chen L, et al. The evidence of SARS-CoV-2 infection on ocular surface. Ocul Surf. 2020;18(3):360-362.
  12. Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020;138(5):575-578.
  13. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. 2020;92(6):589-594.
  14. Colavita F, Lapa D, Carletti F, et al. SARS-CoV-2 Isolation from ocular secretions of a patient with COVID-19 in Italy with prolonged viral RNA detection. Ann Intern Med. 2020;173(3):242-243.
  15. Chen L, Liu M, Zhang Z, et al. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol. 2020;104(6):748-751.
  16. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720.
  17. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. 2020;92(6):589-594.
  18. Yan Y, Diao B, Liu Y, et al. Severe acute respiratory syndrome coronavirus 2 nucleocapsid protein in the ocular tissues of a patient previously infected with coronavirus disease 2019. JAMA Ophthalmol. 2020;138(11):1201-1204.
  19. Penkava J, Muenchhoff M, Badell I, et al. Detection of SARS-CoV-2 RNA in post-mortem samples of human eyes. Graefes Arch Clin Exp Ophthalmol. 2022;260(5):1789-1797.
  20. Bayyoud T, Iftner A, Iftner T, et al. Absence of severe acute respiratory syndrome-coronavirus-2 RNA in ocular tissues. Cornea. 2020;19:100805.
  21. Mahalingam K, Angmo D, Kakkar A, et al. Analysis of SARS-CoV-2 in corneal tissue of deceased asymptomatic novel coronavirus disease 2019 donors. Cornea. 2022;41(12):1559-1563.
  22. Sawant OB, Singh S, Wright RE, et al. Prevalence of SARS-CoV-2 in human post-mortem ocular tissues. Ocul Surf. 2021;19:322-329.
  23. Ferrari S, Franco E, Del Vecchio C, et al. Presence of SARS-CoV-2 RNA in human corneal tissues donated in Italy during the COVID-19 pandemic. BMJ Open Ophthalmol. 2022;7(1):e000990.
  24. Casagrande M, Fitzek A, Spitzer MS, et al. Presence of SARS-CoV-2 RNA in the cornea of viremic patients with COVID-19. JAMA Ophthalmol. 2021;139(4):383-388.
  25. Miner JJ, Platt DJ, Ghaznavi CM, et al. HSV-1 and Zika virus but not SARS-CoV-2 replicate in the human cornea and are restricted by corneal type III interferon. Cell Rep. 2020;33(5):108339.
  26. O’Brien SF, Lewin A, Yi Q-L, Dowling G, Fissette E, Drews SJ. The estimated risk of SARS-CoV- 2 infection via cornea transplant in Canada. Cell Tissue Bank. 2021;22(4):685-695.

 

DR. BALLOUZ practices at the Kellogg Eye Center at the University of Michigan, Ann Arbor. Her research has been published in Cornea and BMC Ophthalmology. She reports no disclosures. 

DR. MIAN is interim chair and professor in the dept. of ophthalmology and visual sciences at University of Michigan Medical School. He served on the board of directors and as a medical director of the Midwest Eye-Banks. He currently serves as a board member of the Cornea Society. He reports no disclosures. 

 

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