Careful and ongoing observation of IOP, especially in the first year after PK, is recommended for patients after penetrating keratoplasty and prompt treatment of IOP elevation when indicated. Early filtering surgery with a better outcome than other surgery procedures should be preferred if medical treatment is not sufficient. Despite anti-glaucoma therapy, good visual outcome can remain beyond expectations despite a clear graft. While there is a potential option for graft exchange, damage to the optic nerve from end-stage glaucoma leads immutably to visual loss.

This study helps to estimate the contamination risk of a cultured cornea based on specific donor factors. However, donors with risk factors should not be generally excluded from cornea donation. Further studies including antibiograms might clarify whether a change in the antibiotic composition of the culture medium would be useful to deal with the increasing number of multi-resistant microbes.

The final consent rate was only 6 % out of all potential donors. Organisational failure was only 16 % in contrast to 60 % refusal due to causes relating to medical staff and relatives. Therefore, further education of physicians and the public is needed.

Background Ever since the first successful keratoplasty in 1905, there has been a need to store corneas for transplantation. R. Townley Paton founded the first eye bank in New York in 1944. With Helen Kellerʼs call in 1925 for LIONS to “constitute themselves Knights of the Blind in the crusade against darkness”, LIONS Clubs International has become involved in the establishment of eye banks worldwide. This paper presents the development of eye banking in general and with special attention to the support offered by LIONS Clubs. Methods Selective literature search through PubMed, Google Scholar and Google in close cooperation with the LIONS Eye Banks already established in Germany, LIONS Clubs International (USA) and the Julius Hirschberg Society (Austria). Analysis focused on the founding processes of 6 German eye banks and their current services. Results Filatov was the first to keep donor eyes in a cool, moist container for a few days. In 1973, Summerlin et al described the technique of organ culture for donor corneas, and McCarey & Kaufman described a liquid storage medium in 1974. LIONS Clubs International and their organisational structure first supported an eye bank in the US in 1952, outside America in Hong Kong in 1962 and in Germany in 1969. Funding is provided across all levels of LIONS as network support and material resources. In general, staff funding is not provided. Of the 88 eye banks operating worldwide today, 44 are called LIONS Eye Banks. 6 of the current 26 eye banks in Germany are operating under LIONS sponsorship and run by departments of ophthalmology at university medical centres. Although the number of transplants has increased in recent years due to new surgical techniques, the number of patients waiting for donor tissue is also growing as a result of the broadening indication. Conclusions Even today, the availability of donor corneas limits patient care. Eye banks help to meet the need for donor corneas. However, the techniques and technical equipment of eye banks must undergo continuous improvement. The local, national and international network of LIONS Clubs can assist in establishing these in order to facilitate legal requirements and structural developments. This support frequently lasts for many years, often triggers additional public commitment and is thus also a supporting element for the future development of eye banking in Germany.

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Purpose In the majority of European countries there is a shortage of donor corneas for corneal transplantations. In 2007, the EU Directive 2006/17/EC on ‘technical requirements for the donation, procurement and testing of human tissues and cells’ was introduced restricting the usability of post‐mortem donor blood sampling from 72 hours to 24 hours. As a consequence, post‐mortem time for donor cornea acquisition was shortened, resulting in a further reduction of corneal allografts. This study analyzed the effect of donor cornea post mortem‐time on medium contamination in organ culture storage. Methods Contamination rates during corneal organ culture during extended (2008‐9, Group I) versus restricted post‐mortem time protocols (2010‐11, Group II) were retrospectively analyzed. Data were collected at LIONS Cornea Bank North Rhine‐Westphalia, University Eye Hospital Duesseldorf, Germany. Results In the years 2008 and 2009 (Group I) 1272 corneal grafts with a post‐mortem time of 30.05 ± 15.77 hours were collected and cultivated in LIONS Cornea Bank NRW. After introduction of the new guidelines, the overall number of acquired donor corneas dropped by 29.88% to 892. Post‐mortem time was significantly lower during the restricted post‐mortem time protocols (24.2 ± 12.37 hours, p<0.05, t‐test). Interestingly, there was no significant difference of culture medium contamination rates between the two groups (Group I: 9,0%, n=115 versus Group II: 7.3%, n=65; Chi‐squared test). Conclusion Restriction of donor cornea acquisition time down to 24 hours seems to be without benefit regarding the contamination rates during corneal organ culture.