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N. C. Steinle, W. S. VanMeter, D. G. Katz, G. Wortz, M. H. Bradley, L. Astleford, J. M. Rouse; Examination of Corneal Graft Opacifications Resulting From Chemotherapeutic Agents Administered to Corneal Donors. Invest. Ophthalmol. Vis. Sci. 2009;50(13):645.
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According to the Eye Bank Association of America, cancer deaths comprised 19.2% of EBAA corneal donors in 2005 and 2006. Using both statistical and histopathological analyses, this study examines the long term consequences of corneal grafts harvested from donors who underwent systemic chemotherapy treatment prior to death.
One hundred and twenty consecutive eye bank donor charts of corneas used in penetrating keratoplasty procedures from July 2003 through July 2006 were retrospectively reviewed. All consecutive charts were donors used by a single corneal surgeon and were exclusively followed post operatively by the same single corneal surgeon for a minimum of two years. Recipient records of those patients receiving tissue from donors recently undergoing systemic chemotherapy were reviewed. The type of chemotherapy and method of administration where then identified. Corneal clarity, post operative ocular surface disease, and length of graft survival were recorded. Histopathological analysis of failed corneal grafts harvested from donors who underwent systemic chemotherapy treatment prior to death was performed.
Twenty-nine of 120 (24.16%) cornea donor charts specified cancer as a primary cause of death. Five of these 29 (17.24%) donors had undergone systemic chemotherapy within the eight weeks immediately prior to death. Chemotherapeutic agents utilized included paclitaxel, carboplatin, cisplatin, etoposide, gemcitabine, and fluorouracil. All five recipients (100%) developed post operative central subepithelial opacification within the two year follow up period. Central corneal opacification was severe enough in four of the five patients (80%) to require regrafting for visual improvement. The mean time interval between initial penetrating keratoplasty and regraft was 488 days (1.34 years). Histopathology of the failed grafts showed marked abnormality of the central epithelial basement membrane, apoptosis of basal epithelial cells, thinning of the epithelial cell layer with focal epithelial erosion, and underlying devitalized connective tissue with stromal fibrosis.
Corneas harvested from donors who underwent recent systemic chemotherapy administration may be associated with central subepithelial opacification in post keratoplasty recipients. Cancer related deaths are projected to increase in the future; therefore, both eye banks and cornea surgeons should recognize the potential for complication in utilizing donor tissue from patients with a history of recent systemic chemotherapy administration.
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