Editorial
Changing inclinations of eye banking cornea modeling with 3D printing, it remains to be seen if it will
Sight is the noblest sense of man.
‑ Albrecht Durer
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The role of eye banking practices remains crucial in the
eradication of corneal blindness. Eye banks are constantly
challenged by the limitation of unsteady donor corneal tissue
availability and donor tissue‑related infection concerns.
Decreasing donor corneal tissue demand, optimal tissue
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sharing practices, improved eye banking personnel training,
better access of remote populations to trained corneal
surgeons, improving donor storage media, and provision of
precut‑preloaded donor tissues for endothelial transplants are
some of the concerns in the expanding scope of eye banking
practices. Eye banks are also facing the challenge of distribution
of high‑quality donor tissues, given the medical advancements
in communicable disease management that enable viral load
reduction and disease cure.[1] Whether the donor corneal tissue
of such voluntary donors will be suitable for eye banking
practices is a matter that will become a reality soon. This brings
to the forefront the question of revisiting the donor deferral
criteria for eye banks, transplantation regulators, and standard
setting organizations, especially in societies with a higher
prevalence of communicable infectious diseases. Estimation of
SARS‑CoV‑2 colonization in ocular tissues, long‑term corneal
preservation, new disinfection strategies, alternatives to donor
corneal tissues, custom corneal transplants, and cell‑based
therapies for the treatment of corneal disease were some of the
avenues that were widely explored during the recent COVID
pandemic’.[2‑4]
Although long‑term follow‑up data are lacking, preloaded
Descemet membrane endothelial keratoplasty (pDMEK) has
been recommended to be more cost‑effective in comparison to
that of non‑preloaded DMEK (n‑pDMEK).[5] Eye banks need to
work toward optimal provision of preloaded tissues to enable
surgeons adopt DMEK more effectually into their practices.
A recent report on the effective storage of human corneas for
3 months in the Active Storage Machine (ASM) that establishes
intra‑ocular pressure and medium renewal shows optimism on
extending eye banking perspectives to experimental research.[6]
The constant challenge of meeting the increasing demand
for transplantable donor corneal tissues, which is faced by
eye banks world over, has fueled research to explore alternate
avenues. The concept of clinical application of corneal stromal
replacement therefore has been widely researched in recent
times. Research on biosynthetic corneal substitutes such as
synthetic inert keratoprostheses, acellular scaffolds with
and without enhancement of endogenous regeneration, and
cell‑based replacements[7] has come to the center stage in recent
times. Corneal tissue bioengineering research is encountered
with concerns in isolation and stable expansion of the various
cell types required for effective corneal regeneration. Current
trends in experimental and preclinical research in this area
hover around a combined approach of integration of stem
cell expansion and a biological or synthetic scaffold.[8] With
promising research work going into artificial biosynthetic
© 2023 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
be able to attain suitable optical clarity, tectonic integrity, and
biocompatibility.[9] Future prospects of eye bank functioning
look at the integration of donor tissue logistics with that of
research related to human pluripotent stem cell lines for use
in cell therapy manufacturing.[10]
Besides providing support to the training of eye banking
personnel and corneal transplant surgeons in remote areas,
functioning eye banking model establishments in various
nations are moving toward innovative research pertaining
to pluripotent stem cell, corneal epithelial, stromal, and
endothelial stem cell bioengineering. A paradigm shift in
healthcare related to eye banking is now witnessing a rise
in “venture philanthropy” practices of not‑for‑profit eye
banking models, which coexist with regional eye banks and
are working toward spearheading innovative research related
to donor corneal tissues through their profit‑based subsidiary
establishments.[11] Several ethical questions remain in the face
of such functioning eye banking model establishments, which
claim to integrate patient, surgeon, donor, and practice logistics
related to eye banking and research.
Among all these rising concerns, on the occasion of
38th National Eye Donation Fortnight (August 25 to September 8),
we raise an oath to honor the memory of all those donors for
their act of supreme kindness to humanity.
M Vanathi
Cornea and Ocular Surface, Cataract and Refractive
Services, Dr R P Centre for Ophthalmic Sciences,
All India Institute of Medical Sciences,
New Delhi, India.
E‑mail: mvanathi.rpc@gmail.com
References
1. Individual Risk Assessment. Int J Eye Banking 2021;9:1. www.
eyebankingjournal.org.
2. Aiello F, Gallo Afflitto G, Pocobelli G, Ponzin D, Nucci C. Effect
of Covid‑19 on Eye Banks and Corneal Transplantations: Current
perspectives. Clin Ophthalmol 2022;16:4345‑54.
3. Madkaiker A, Venugopal A, Ghorpade A, Ravindran M, Ragappa R,
Sithiq MU. Eye banking and keratoplasty trend analysis during the
COVID‑19 pandemic: A South Indian observational study. Indian
J Ophthalmol 2023;71:498‑502.
4. Roy A, Das S, Chaurasia S, Fernandes M, Murthy S. Corneal
transplantation and eye banking practices during COVID‑19‑related
lockdown period in India from a network of tertiary eye care
centers. Indian J Ophthalmol 2020;68:2368‑71.
5. Böhm M, Leon P, Wylęgała A, Ong Tone S, Condron T, Jurkunas U.
Cost‑effectiveness analysis of preloaded versus non‑preloaded
Descemet membrane endothelial keratoplasty for the treatment
of Fuchs endothelial corneal dystrophy in an academic centre. Br
J Ophthalmol 2022;106:914‑22.
6. Garcin T, Gauthier AS, Crouzet E, He Z, Herbepin P, Perrache C,
et al. Three‑month storage of human corneas in an active storage
machine. Transplantation 2020;104:1159‑65.
7. B r u n e t t e I , R o b e r t s C J , Vi d a l F , H a r i s s i ‑ D a g h e r M ,
Lachaine J, Sheardown H, et al. Alternatives to eye bank native
tissue for corneal stromal replacement. Prog Retin Eye Res
2017;59:97‑130.
 3122 Indian Journal of Ophthalmology Volume 71 Issue 9

8. Branch MJ, Yu WY, Sheridan C, Hopkinson A. Isolation of adult

stem cell populations from the human cornea. Methods Mol Biol
2015;1235:165‑77.
9. Jia S, Bu Y, Lau DA, Lin Z, Sun T, Lu WW et al. Advances in 3D
bioprinting technology for functional corneal reconstruction
and regeneration. Front Bioeng Biotechnol 2023;10:1065460. doi:
10.3389/fbioe.2022.1065460.
10. Kim JH, Kawase E, Bharti K, Karnieli O, Arakawa Y, Stacey G.
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DOI:
11. Moshirfar M, Goldberg JL, Brown TW, Wagner WD, Ronquillo YC. 10.4103/IJO.IJO_2170_23
A paradigm shift in eye banking: How new models are challenging
the status quo. Clin Ophthalmol 2018;13:63‑7. PMID:
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Cite this article as: Vanathi M. Changing inclinations of eye banking. Indian
J Ophthalmol 2023;71:3121-2.