Purpose To report on the occurrence of guttae in corneal donor tissue.
Material & Methods Retrospective database study of discard reasons for corneal donor tissue at Amnitrans EyeBank Rotterdam (AER) for the period from January 2019 to December 2021 and the outcome of an eight-question survey sent to European Eye Bank Association corresponding members addressing the occurrence of corneal guttae and the practice pattern regarding donor tissue with guttae.
Results Between 2019 and 2021 6039 donor corneas were processed at AER. Average discard rate because of guttae in this period was 9 (±4)% (n=552). Most corneas were discarded because of guttae at first evaluation (8%, n=481). Monthly discard rate because of guttae ranged from 3% to 19%. Yearly discard rates related to corneal guttae were 10 (±3)%, 8 (±3)% and 11 (±5)% in 2019, 2020 and 2021, respectively. Average endothelial cell density (ECD) at the first evaluation from 2019-2021 was 2486 (±93) cells/mm2, with average monthly ECD ranging from 2343 to 2642 cells/mm2.
Twenty-nine eye banks completed the survey, including 4 located outside Europe. 70% reported a guttae-related discard rate of ≤4. The types of microscope used for the evaluation, the geographical location and the number of guttae permitted do not seem to influence the discard rates. 13 eye banks permitted 0 guttae while 10 banks accepted between 1-10 guttae.
The 16 eye banks that responded ‘no’ to the question whether the contralateral cornea of a guttae-cornea was automatically discarded did report a lower guttae-related discard rate than the other eye banks.
Conclusion The high variability of the discard rate due to guttae in donor corneas (ranging from <1% and >12%) is an indication that it is not always easy to detect guttae in donor corneas. Although transplanting corneal grafts with guttae does not necessarily mean that a re-transplantation will be needed on the short term, a vital method to unequivocally determine the presence of guttae in the eye bank seems essential to prevent unnecessary waste of suspect tissue and unnecessary re-surgeries.
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