Title : Evolving strategies in tissue procurement preservation and distribution to maximize corneal tissue utilization a fifteen year experience
Abstract:
Background: The paradigm of corneal transplantation has rapidly transitioned from penetrating keratoplasty (PK) to lamellar (e.g., DALK, ALK) and endothelia ltechniques (e.g., DMEK, DSAEK). Successful eye banking requires continuous adaptation in tissue preparation and preservation to maximize tissue viability and utilization while upholding rigorous safety standards. This presentation analyzes the 15-year operational evolution of the Roman Eye Bank’s comprehensive algorithm for tissue procurement, storage, and distribution, highlighting key strategic and technical innovations.
Methods: A detailed temporal analysis of corneal graft distribution, broken down by surgical technique, and comparison of local trends with contemporary international allocation patterns will be discussed. The influence of corneal graft distribution patterns on tissue utilization will be analyzed. Furthermore, the methodological details of advanced preoperative tissue preparation, including an algorithm for predicting DSAEK lamellar grafts thickness will be presented.
Results: The comprehensive analysis of 15 years of tissue distribution data clearly demonstrates a pronounced shift, characterized by a substantial reduction of grafts for PK (>70% in 2010; <35% in 2025) and a significant surge of grafts for DALK, LK (<15% in 2010; >20% in 2025) and grafts for DMEK and DSAEK (<15% in 2010; >50% in 2025). Critically, we observed an 24.5% increase of tissue utilization driven by the proactive selection of tissues previously deemed unsuitable for PK or endothelial techniques for lamellar procedures. Another central component of the Roman strategy is the double-use approach, which utilizes both traditional organ culture and the Eusol-C hypothermic storage medium to maximize tissue viability and storage time, while reducing tissue contamination. The Roman protocol for DSAEK-graft preparation achieved the desired graft thickness without perforation reliably and identified donor precut thickness and microkeratome blade choice as the main predictive factors for graft thickness (pseudo-R²= 45,73%).
Conclusion: The Roman Eye Bank's 15-year experience validates the critical importance of adopting and investing in novel preservation strategies and sophisticated graft preparation techniques for modern corneal surgery. This innovative, combined approach has allowed the Eye Bank to effectively meet the evolving demand for lamellar and endothelial grafts, thereby maximizing tissue utilization and significantly boosting overall operational efficiency. We conclude that robust communication and collaboration between eye banks and corneal surgeons is the definitive key to optimizing tissue distribution and broadening access to sight-restoring surgery for the largest number of patients possible.
