SARS-CoV-2 infection status in corneal preservation solution and COVID-19 prevalence after corneal transplantation

Abstract

Purpose : The potential risk of COVID-19 infection from corneal transplants associated with donor corneas during the COVID-19 pandemic was unknown. To minimize this risk, we performed PCR for SARS-CoV-2 in corneal preservation fluid to confirm the presence of SARS-CoV-2 infection in donors who were not systemically negative for SARS-CoV-2 at the time of donation. We also examined the postoperative health status of the recipients.

Methods : This study included 144 corneal transplants in 143 eyes performed between November 2020 and October 2022 at the Department of Ophthalmology, Yamaguchi University Hospital.
Preoperatively, PCR for SARS-CoV-2 was performed at our hospital on corneal preservatives from donors who had not been confirmed as negative for SARS-CoV-2 at the donor source to confirm the presence of SARS-CoV-2 infection.

Results : Of the 144 transplants in 143 eyes, 130 transplants in 129 eyes were performed using imported corneas from the U.S. of CorneaGen, and 14 transplants in 14 eyes were performed using corneas donated within Yamaguchi Prefecture. We performed PCR in 109 eyes (99 of which were imported corneas and 10 were donated in Yamaguchi Prefecture), and 100% of them were negative for COVID-19. Thirty-four eyes (30 of which were imported corneas from the U.S. and 4 were donated in Yamaguchi Prefecture) had already been confirmed negative for COVID-19 using nasopharyngeal swab fluid at a previous institution hospital or eye bank, we were not subjected to PCR.
All recipients were admitted to the hospital and underwent corneal transplantation surgery after PCR testing using nasopharyngeal swabs confirmed negative for corona. During the approximately 2-week postoperative hospitalization period, all patients showed no symptoms of COVID-19 infection.

Conclusions : Because of the immunosuppression with steroids after corneal transplantation, there is high risk for serious conditions if COVID-19 infection should occur in the recipient, so we must be very careful to avoid the development of COVID-19 infections via donor corneas. Regarding COVID-19 infection through the donor cornea, it may not be necessary to PCR the preservation fluid since COVID-19 was not detected in the corneal preservation fluid in the present results. However, we considered it important to conduct a COVID-19 detection test of nasopharyngeal swab fluid as a donor test as well as other viral tests.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.