Alcohol Abuse Is Associated With Alterations in Corneal Endothelial Cell Morphology

PURPOSE: Alcohol consumption is highly prevalent throughout the world. We sought to detect, in a large sample of cornea donors, whether alcohol abuse is associated with changes in corneal endothelial morphology after accounting for other comorbidities including tobacco use. METHODS: At a single eye bank, 10,322 eyes from a total of 5624 unique donors underwent imaging with a Konan CellChek D specular microscope. Demographic information and medical history were associated with each tissue. Images were analyzed using a standardized protocol for assessment of endothelial cell density, hexagonality, and variation. In this retrospective analysis, a multivariable regression was conducted to assess for an association between alcohol abuse and corneal endothelial metrics. Measurements were averaged across eyes for each donor. Bonferroni corrections were applied to account for multiple comparisons. RESULTS: Among 5624 donors, the mean (standard deviation) endothelial cell density was 2785 (383.0) cells/mm2. Indicators of alcohol abuse were present in 1382 donors (24.5%). In a multivariable regression model that included age, sex, tobacco use, history of cataract surgery, and diabetes mellitus, alcohol abuse was associated with a decrease of 60.9 cells/mm2 [95% confidence interval (CI), -83.0 to -38.7 cells/mm2, P = 7.6 × 10-8], an increase in the coefficient of variation by 0.0048 (95% CI, 0.17-0.79, P = 0.002), and a decrease in percent hexagonality by 0.93% (95% CI, -1.3 to -0.6, P = 4.5 × 10-7). CONCLUSIONS: Alcohol abuse is associated with significant alterations to corneal endothelial density and morphology

Comparison of Corneal Endothelial Cell Density and Morphology With Optisol-GS and Life4C Storage Media in the Eye Bank: A 5-Year Retrospective Analysis

Purpose: Optisol-GS and Life4C are corneal storage media used by eye banks worldwide. We sought to determine whether either solution was associated with superior corneal endothelial cell density (ECD) or morphology in a large cohort of donor corneas. Methods: From January 2016 to December 2020, 10,316 corneas from 5624 unique donors were acquired and analyzed at Rocky Mountain Lions Eye Bank. In April 2019, Life4C replaced Optisol-GS as the sole storage medium. We compared ECD and morphology before and after April 2019 and excluded corneas processed within the transition period. Univariable and multivariable regression analyses accounted for age, sex, tobacco use, heavy alcohol use, and diabetes. Only right corneas were analyzed to account for the correlation between eyes. Results: Of 5042 right corneas analyzed, 3486 were stored in Optisol-GS and 1556 in Life4C. There was no significant difference in ECD across groups (2794 vs. 2793 cells/mm 2 in Optisol-GS and Life4C, P = 0.88). In multivariate analyses, there was no significant difference in corneal ECD (0.6 cells/mm 2 higher with Life4C, P = 0.96) or hexagonality (0.22% higher with Life4C, P = 0.31). However, the coefficient of variation was significantly lower in the Life4C group (−0.0039, P = 0.03). After adjustment for above factors, corneas in Life4C demonstrated a 3.1% decreased likelihood of exhibiting coefficient of variation (CV) values greater than 0.40 ( P = 0.009). Conclusions: This study demonstrates comparable and favorable outcomes using both storage media and confirms their overall efficacy. The decreased CV in Life4C is not of clinically significant magnitude but merits further research in clinical and long-term settings

Viability of preloaded Descemet membrane endothelial keratoplasty grafts with 96-hour shipment

Objective To assess feasibility and compare the effects of 96-hour shipment of Descemet membrane endothelial keratoplasty (DMEK) grafts as a scroll or a tri-fold on cell viability.Methods and analysis DMEK grafts were prepared at the Rocky Mountain Lions Eye Bank. Twenty pre-stripped DMEK grafts, paired from 10 donors, were either tri-folded in an endothelium-in configuration using microforceps and loaded into a plastic Treyetech cartridge, or suctioned in a scrolled endothelium-out configuration into a modified Jones Tube. Grafts were shipped via FedEx to a secondary location and back for 48 hours each way, resulting in a total shipping time of 96 hours. After shipping, grafts were removed from inserters onto glass slides and unfolded using viscoelastic with endothelium facing upwards. Calcein-AM stained grafts were imaged with a fluorescent microscope and endothelial cell loss (ECL) was measured using trainable segmentation in Fiji by a masked grader.Results A total of 20 grafts were shipped for 96 hours, split between preloaded tri-folded (n=10) and preloaded scrolled (n=10) tissues. No significant difference in ECL was observed across groups after prolonged shipping (14.8% vs 13.7% ECL respectively, p=0.68).Conclusion For preloaded DMEK after 96 hours, both scrolled and tri-folded tissue demonstrated clinically acceptable levels of ECL. The data suggest a wider window of time for endothelial cell viability and is promising for the prospect of international shipment of preloaded grafts