Purpose: To determine the changes of corneal thickness and curvature of human corneal grafts in organ culture medium II, containing dextran T500 6%, before keratoplasty. Methods:We examined the tomography of 24 corneas from our eye bank transferred from medium I into medium II. Images were repeated hourly during 24 hours using an anterior segment optical coherence tomography. The central corneal thickness (CCT) was measured with the manual measurement tool of the anterior segment optical coherence tomography. The radii of curvature (anterior flat and steep and posterior flat and steep) were measured with a MATLAB self-programmed software for "sterile donor tomography."Results: The mean CCT (6SD) at baseline (T0) was 727 6

Background and Objective Sterile donor tomography enables the detection of corneal tissues with refractive anomalies. The aim of this study was to determine the curvature and thickness of donor corneas to support proper selection in the eye bank. Methods 704 donor corneas (Klaus Faber Center, LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, in Homburg/Saar) were measured using the anterior segment optical coherence tomograph (AS-OCT) CASIA 2 (Tomey Corp., Nagoya, Japan). The corneoscleral discs were measured in their cell culture flask, which was positioned in a holder on the chin rest of the AS-OCT, after conversion to medium II (with 6% dextran T-500). The measured raw data were analysed and processed in MATLAB (MathWorks Inc., Natick, Massachusetts, USA), after which the refractive power of the steep and flat meridian at the anterior and posterior surface and the central corneal thickness (CCT) of the donor corneas were determined. Results values are expressed as mean x̅ ± standard deviation SD. Results The mean refractive power of the steep/flat meridian at the anterior surface was 45.4 ± 1.8 D/44.0 ± 1.3 D, the corresponding values for the posterior surface were − 6.2 ± 0.3 D/− 5.9 ± 0.2 D, and the mean CCT was 616.3 ± 85.1 µm. Of the 704 (100%) measured donor tissues, 590 (83.8%)/670 (95.2%) donor corneas showed no anomaly beyond respectively x̅ ± 2 SD/x̅ ± 3 SD among the 5 examined parameters. 72 (10.3%)/23 (3.3%) donor corneas had only 1 anomaly, 26 (3.7%)/10 (1.4%) had 2 anomalies, 10 (1.4%)/1 (0.1%), 3 anomalies, 5 (0.7%)/0 (0.0%), 4 anomalies, and 1 (0.1%)/0 (0.0%), 5 anomalies. Conclusions AS-OCT provides an objective and sterile screening method to identify corneal tissues with curvature anomalies in order to further optimise donor selection in the eye bank. To avoid postoperative refractive surprises, donor corneas with a total refractive power that deviates > ± 3 SD from the mean should not be used for penetrating or anterior lamellar keratoplasty, but may be suitable for posterior lamellar keratoplasty (DMEK or DSAEK). In the future, sterile donor tomography could enable: (1) the harmonisation of donor and recipient tomography, which may minimise residual astigmatism for a particular donor-recipient pair; and (2) the improvement of IOL power calculation in a classical triple procedure by means of regression analysis between pre- and postoperative total refractive power of corneal grafts.

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Zusammenfassung Hintergrund Seit 2018 verwenden wir die sterile Spendertomographie in der Hornhautbank routinemäßig, um refraktive Überraschungen nach Keratoplastik zu vermeiden. Ziel dieser Studie war es, Spendertomographieparameter mit Tomographieparametern des Transplantates nach perforierender Keratoplastik (PKP) zu vergleichen. Methoden Diese Studie umfasste 193 Spendergewebe der Hornhautbank, die für eine PKP verwendet wurden (Transplantatdurchmesser 8,2 ± 0,7 mm). Messungen wurden mit dem optischen Kohärenztomographen des vorderen Augenabschnittes (VAA-OCT) Casia 2 (Tomey Corp., Nagoya, Japan) präoperativ sowie postoperativ nach 5 ± 4 Monaten bei liegenden Fäden und nach 22 ± 4 Monaten ohne Fäden durchgeführt. Post- und präoperative Werte wurden mithilfe des Wilcoxon-Rangsummentests verglichen. Ergebnisse Postoperativ, bei liegenden (bzw. ohne) Fäden, war die Brechkraft (P) der Hornhautvorderfläche (v) im steilen Meridian (S) (PvS) unverändert (−0,2 dpt; p = 0,78) (um 2,7 dpt größer [p < 0,01]) und im flachen Meridian (F) (PvF) um 4,5 dpt (2,8 dpt) niedriger (p < 0,01) im Vergleich zu den Spendertomographiewerten. Der Astigmatismus (v) war um 4,3 dpt (5,4 dpt) größer (p < 0,01). An der Rückfläche (r) war PrS um 0,9 dpt (0,9 dpt) und PrF um 0,3 dpt (p < 0,01) (0,1 dpt [p = 0,42]) kleiner, während der Astigmatismus (r) um 0,7 dpt (0,9 dpt) größer war (p < 0,01). Die zentrale Hornhautdicke war um 55,7 μm (p < 0,01) (27,5 µm [p = 0,01]) kleiner. Die Gesamtbrechkraft ohne Fäden änderte sich nicht signifikant im Vergleich zur Hornhautbankmessung. Schlussfolgerung Zentrale Hornhautdicke, Brechkraft (P) und Astigmatismus veränderten sich postoperativ im Vergleich zu den Spendertomographiewerten, mit Ausnahme von P im steilen Meridian der Vorderfläche bei liegenden Fäden sowie von P im flachen Meridian der Rückfläche nach Entfernung aller Fäden. Die Gesamtbrechkraft ohne Fäden ändert sich allerdings nicht signifikant. Diese Informationen könnten für eine Verbesserung der Kunstlinsenberechnung bei klassischer „Triple-Procedure“ von Bedeutung sein.

To evaluate the reliability and efficiency of sterile pachymetric measurements of donor corneas based on tomographic data using two different methods: a “manual” and a “(semi-)automated” method. Twenty-five (25) donor corneas (50%) stored in MI and 25 (50%) in MII were imaged 5 times consecutively using an anterior segment OCT (AS-OCT). The central corneal thickness (CCT) was measured both with the manual measurement tool of the AS-OCT (= CCTm) and with a MATLAB self-programmed software allowing (semi-)automated analysis (= CCTa). We analyzed the reliability of CCTm and CCTa using Cronbach´s alpha (α) and Wilcoxon signed-Rank Test. Concerning CCTm, 68 measurements (54.4%) in MI and 46 (36.8%) in MII presented distortions in the imaged 3D-volumes and were discarded. Concerning CCTa, 5 (4%) in MI and 1 (0.8%) in MII were not analyzable. The mean (± SD) CCTm was 1129 ± 6.8 in MI and 820 ± 5.1 µm in MII. The mean CCTa was 1149 ± 2.7 and 811 ± 2.4 µm, respectively. Both methods showed a high reliability with a Cronbach´s α for CCTm of 1.0 (MI/MII) and for CCTa of 0.99 (MI) and 1.0 (MII). Nevertheless, the mean SD of the 5 measurements was significantly higher for CCTm compared to CCTa in MI (p = 0.03), but not in MII (p = 0.92). Sterile donor tomography proves to be highly reliable for assessment of CCT with both methods. However, due to frequent distortions regarding the manual method, the (semi-)automated method is more efficient and should be preferred.

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costly inefficiencies exist in the current fragmented donation and transplantation ecosystem: systems operate in silos without seamless sharing of key data. A modern, interoperable digital system can directly increase the number of eyes procured and transplanted. Methods We hypothesize that the use of the comprehensive iTransplant™ platform increases the number of eyes procured and transplanted. The platform is a modern web-based system which provides comprehensive workflow coverage for eye banking, advanced communication tools, a portal for eye surgeons to submit requests, and secure digital interfaces with external systems such as hospital EMRs, medical examiner/coroner case management systems, and laboratory LIS systems. With these interfaces, referrals, hospital charts and test results are received securely in real-time.Results At over 80 tissue and eye banks in the United States, the use of iTransplant™ has led to a significant increase in referrals and eyes transplanted. Over a period of 19 months in 1 hospital system, during which the only major process change was the adoption of the iReferral™ electronic interface to automate donor referrals, the annualized average shows a 46% increase in referrals and a 15% increase in tissue/eye donors. Over the same time period, the integration with lab systems saved over 1,400 hours of staff time and increased patient safety by eliminating manual transcription of lab results. Conclusions Continued successful results are achieved internationally in increasing the number of procured and transplanted eyes as a result of: (1) the automated, seamless, and electronic receipt of referrals and donor data by eye banks in their iTransplant™ Platform, (2) the elimination of manual data transcription, and (3) the increase in the quality and timeliness of patients' data being available to donation and transplantation professionals.

Purpose Epidemic keratoconjunctivitis (EKC) is one of the most severe ocular viral infections. The aim of this interruptive time series study was to quantitatively evaluate the effectiveness of a hygienic EKC outbreak management concept developed in our ophthalmological department. Methods All patients with suspected EKC in the period from August to November 2018 were included in the study. Data were retrospectively collected from the patient’s medical documents and records. The disease was diagnosed clinically and confirmed by virus detection through polymerase chain reaction (PCR) from conjunctival swabs. With the beginning of the epidemic, an outbreak management plan was implemented to reduce the nosocomial spread. Results The outbreak lasted 77 days (20th August 2018 to 4th November 2018) and affected a total of 120 patients. This corresponds to a mean of 1.5 patients per outbreak day. The median age was 58 [1–92] years. Of all patients, 61 (50.8%) were female. Conjunctival swabs were collected in 100/120 (83.3%) cases, the adenovirus being detected in all positive smears (63/63, 100%). The implementation of our outbreak management plan reduced significantly the number of EKC cases per outbreak day and resulted in a reduction of the basic reproduction number by a factor of 2.2. Conclusion The detection of EKC together with the immediate implementation of hygienic outbreak measures can significantly reduce the spread of infection. The implementation of a strict outbreak management concept can significantly reduce the number of EKC cases, thus avoiding possible complications and therefore unnecessary health-related costs.