Purpose With many health and policy issues arising from COVID-19, the Hospital Authority Eye Bank of Hong Kong encountered challenges related to ocular donor suitability and availability. This review aims to analyse the impact of a global pandemic on corneal donation and transplantation in 2020 and 2021, compared to the pre-COVID period in 2019.

Methods This cohort study evaluated data collected from the Hospital Authority Eye Bank from January 2019 to December 2021. The number of corneas harvested, including voluntary donations initiated by the deceased’s relatives and approached cases by Eye Donation Coordinators, tissue distributed, transplanted and disposed, the reason for disposal as well as the usage of the transplanted corneas in 2020 and 2021 were compared to the pre-COVID period of 2019.

Results The number of corneas harvested dropped by 17.6% in 2020 compared to the pre-COVID period of 2019, and rose almost back to baseline in 2021. However, despite having near-normal number of harvested corneas in 2021, the number of corneal transplants using fresh corneas were still reduced by 30% in 2020 and 27% 2021. The observation can be explained by the seven-fold increment in disposal due to suboptimal quality from a cancer donor in 2021. The proportion of corneas used for optical, therapeutic and tectonic purposes remained stable throughout the three years.

Conclusion COVID-19 yielded brief periods of service interruption and reduced number of eligible donors, leading to a noticeable rise in solicitation from cancer donors in 2021. The pandemic resulted in a longer corneal transplant waiting time. Nevertheless, The proportion of different corneal transplantation remained stable, with even the development in new techniques such as Descemet’s Membrane Endothelial Keratoplasty and enhancement in services such as provision of ultra-fresh Keratolimbal allografts despite the limitations in the COVID-19 era.