RON JANS CLINICAL CORNEA RESEARCH AWARD WINNER

Authors: Maria Elena Montpetit Gonzalez, Johanna Choremis, Michèle Mabon, Tanguy Boutin, Leila Mejdoub, Isabelle Brunette, Julia Talajic
Author Disclosure Block: M. Montpetit Gonzalez: None. J. Choremis: Consultant; Shire, Santen, Allergan, Bausch and Lomb, Labtician-thea. Membership on advisory boards or speakers’ bureaus; Shire, Santen, Allergan. Other investments or relationships; PRN pharmaceuticals. M. Mabon: Patents on a drug, product or device; PRN pharmaceuticals. T. Boutin: None. L. Mejdoub: None. I. Brunette: Membership on advisory boards or speakers’ bureaus; ESCRS lecture fees. Funded grants or clinical trials; FROUM Fonds de recherche ophtalmologie Université de Montréal, Abbott Medical Optics grant support, CIHR grant support, FRQS grant support, NSERC grant, Valeant Canada grant.Patents on a drug, product or device; US Provisional 62/557,503:05015490-117USPR. J. Talajic: Funded grants or clinical trials; Fonds de recherche ophtalmologie Université de Montréal.

Abstract Body:

Purpose: The average preservation time (PT) of donor corneas at Hôpital Maisonneuve-Rosemont (HMR) is 8 to 9 days according to Héma-Québec, but corneas are frequently used up to 14 days. In the United States the vast majority of corneas are stored for fewer than 8 days, as many surgeons reject donor tissue that has been stored for longer. The effect of PT on DMEK has not yet been studied. Therefore, our overall goal is to determine if a longer PT has an impact on the outcome of DMEK cornea transplants.
Study Design: This is an ambispective cohort observational study involving 2 study groups. Group 1: Donor cornea preserved ≤7 days, Group 2: >7 to 14 days.
Methods: Thirty-six eyes of 32 patients that underwent DMEK at HMR between April 2015 and February 2018 were studied. Eyes were assigned to either group according to their donor cornea PT. Group 1: n=17, and Group 2: n=19. The primary outcome was central endothelial cell density (ECD) at 12 months post-DMEK, and secondary outcome parameters were graft failure and rebubbling rate.
Results: The mean age at surgery was 68 years (range: 48-88 years; 50.2% men). Mean follow-up time was 18.3 months. Mean (±SD) preoperative donor ECD was 2697±337 cells/mmin Group 1 and 2840±319 cells/mm in Group 2. At 1 year, mean ECD decreased to 1261±559 cells/mmand 1190±451 cells/mm, respectively (mean difference, 71 cells/mm; 95% CI -271.65 to 413.65; p= 0.68). This represented an endothelial cell loss of 53±18% in Group 1 and 58±17% in Group 2. 65% of central ECD in Group 1 were over 1000 cells/mm compared to 53% in Group 2. Rebubbling and failure rate were 29% and 0% in Group 1 and 26% and 11% in Group 2. Mean delay from death to preservation was 11.56±5.55 hours in Group 1 and 12.49±6.18 hours in Group 2. Mean delay from stripping to surgery was 2±1.13 days (range: 0-4 days) for Group 1, and 2±1.57 days (range: 0-6 days) for Group 2.
Conclusions: In this small study, PT did not significantly affect DMEK outcomes. A larger sample size is needed. If long PTs negatively impact DMEK this will affect eye bank storage worldwide. Conversely, safe use of longer PTs will allow for an increased DMEK donor pool, reducing waiting lists and facilitating tissue access.