Abstract
Purpose: :
To evaluate the suitability of Down’s Syndrome (DS) donor tissue for corneal transplantation and outcome of stromal corneal transplantation using DS donors.
Methods: :
Retrospective analysis of all DS donor tissues harvested at Utah Lions Eye Bank (ULEB) and outcome of 5 stromal cornea transplants done between 2004 and 2010. Primary outcome for transplant suitability of harvested tissue was endothelial cell count (ECC). Primary outcome for stromal corneal transplants was Best Corrected Visual Acuity (BCVA) and secondary outcomes were Schiempflug imaging and Anterior Segment Optical Coherence Tomography (ASOCT).
Results: :
A total of 21 DS donor corneas were obtained from ULEB between 2004-2010. Eleven out of 21 were found to be suitable for use based on an average ECD count of 3333±971 cells/mm2 (range 1863-4378 cells/mm2), two of which were rejected due to HTLV. Five out of 9 were used in 3 penetrating keratoplasty (PK) and 2 in keratoprosthesis (KPro) procedures. Case 1 had macular dystrophy with baseline BCVA of 20/200 and five year post PK BCVA of 20/25. Case 2 had Fuchs endothelial corneal dystrophy with baseline BCVA of 20/70 and 3 years post PK BCVA of 20/25. Case 3 had keratoconus with baseline BCVA of 20/80 and 2 years post PK BCVA of 20/25. None of the patients in the PK group had any evidence of ectasia based on clinical exam, Schiempflug imaging and ASOCT, with a median follow up of 3 years. Case 4 had Meesman dystrophy with baseline BCVA of HM and 18 months post KPro BCVA of 20/150. Case 5 had limbal stem cell deficiency secondary to alkali burn with baseline BCVA of HM and post KPro BCVA of hand motion secondary to glaucomatous optic neuropathy. No evidence of infection or extrusion was noted in either of the two KP cases.
Conclusions: :
Endothelial cell count was the major determinant in rejection of DS donor tissue. In the PK group, DS corneal donor tissue appeared to provide for a normal corneal contour without evidence of ectasia. In the KPro group, there was no evidence of extrusion or infection. Our case series suggests that DS donor tissue can be used for stromal replacement corneal transplantation, although it was limited due to small sample size. A large multicenter retrospective analysis of DS donor tissue outcomes may be useful in comparing the suitability and outcomes with non DS donor tissue.
Keywords: transplantation • cornea: clinical science • clinical (human) or epidemiologic studies: outcomes/complications