One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe

Thuret, Gilles; Courrier, Emilie; Poinard, Sylvain; Gain, Philippe; Baud’huin, Marc; Martinache, Isabelle; Cursiefen, Claus; Maier, Philip; Hjortdal, Jesper; Ibanez, Jacinto Sanchez; Ponzin, Diego; Ferrari, Stefano; Jones, Gary L. A.; Griffoni, Carlo; Rooney, Paul; Bennett, Kyle; Armitage, W. John; Figueiredo, Francisco C; Nuijts, Rudy M.M.A.; Dickman, Mor M.

doi:10.1136/bjophthalmol-2020-317938

Cited by 33 publications

(51 citation statements)

References 28 publications

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“…This approach helps obviate the need for an emergency therapeutic keratoplasty, which is known to be associated with high risk of graft failure (in the setting of active inflammation) and recurrence of infection 69 , 71 , 72 . It would also help reduce the burden on the availability of donor corneas, which have been significantly affected by the recent COVID-19 pandemic 73 .…”

Section: Discussionmentioning

confidence: 99%

Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

Ting

Henein

Said

et al. 2021

Sci Rep

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Infectious keratitis (IK) is the 5th leading cause of blindness globally. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though adjuvant treatment or surgeries are often required in refractory cases of IK. This systematic review aimed to examine the effectiveness and safety of adjuvant amniotic membrane transplantation (AMT) for treating IK. Electronic databases, including MEDLINE, EMBASE and Cochrane Central, were searched for relevant articles. All clinical studies, including randomized controlled trials (RCTs), non-randomized controlled studies and case series (n > 5), were included. Primary outcome measure was time to complete corneal healing and secondary outcome measures included corrected-distance-visual-acuity (CDVA), uncorrected-distance-visual-acuity (UDVA), corneal vascularization and adverse events. A total of twenty-eight studies (including four RCTs) with 861 eyes were included. When compared to standard antimicrobial treatment alone, adjuvant AMT resulted in shorter mean time to complete corneal healing (− 4.08 days; 95% CI − 6.27 to − 1.88; p < 0.001) and better UDVA (− 0.26 logMAR; − 0.50 to − 0.02; p = 0.04) at 1 month follow-up in moderate-to-severe bacterial and fungal keratitis, with no significant difference in the risk of adverse events (risk ratio 0.80; 0.46–1.38; p = 0.42). One RCT demonstrated that adjuvant AMT resulted in better CDVA and less corneal vascularization at 6 months follow-up (both p < 0.001). None of the RCTs examined the use of adjuvant AMT in herpetic or Acanthamoeba keratitis, though the benefit was supported by a number of case series. In conclusion, AMT serves as a useful adjuvant therapy in improving corneal healing and visual outcome in bacterial and fungal keratitis (low-quality evidence). Further adequately powered, high-quality RCTs are required to ascertain its therapeutic potential, particularly for herpetic and Acanthamoeba keratitis. Future standardization of the core outcome set in IK-related trials would be invaluable.

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Section: Discussionmentioning

confidence: 99%

Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

Ting

Henein

Said

et al. 2021

Sci Rep

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“…Bislang liegt zudem keine Dokumentation einer Übertragung mittels Gewebetransplantation von SARS-CoV-2 vor [26]. Leider zeigte sich jedoch ein deutlicher Rückgang der Spenderzahlen in Europa [27].…”

Section: Okuläre Eintrittspfortenunclassified

Ocular Involvement in COVID-19: Conjunctivitis and More

Rokohl

Grajewski

Matos

et al. 2021

Klin Monbl Augenheilkd

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Since the beginning of 2020, SARS-CoV-2, the pathogen of COVID-19, has led to a global pandemic that also affects ophthalmology. Ophthalmologists can be confronted at any time with potentially COVID-19 associated ocular symptoms or manifestations in patients and also become infected through close patient contact. Even without systemic infection, the ocular surface can come into direct contact with aerosols or liquids containing SARS-CoV-2 particles. A smear infection through hand-to-eye contact is also possible. A purely isolated ocular infection has not yet been shown. Rather, it seems that ocular complications occur in the context of a systemic infection. However, ocular symptoms can also be the first symptom of COVID-19. The most common ocular complication of COVID-19 is mild follicular conjunctivitis. Haemorrhagic conjunctivitis, dry eye disease, episcleritis, or retinal involvement can also occur less frequently. There are currently no evidence-based therapy recommendations for COVID-19 associated diseases of the ocular surface. Artificial tears might be helpful for symptom relief. There is no evidence for antiviral, antibiotic, or anti-inflammatory therapies, but these medications might be used in individual cases. Potential intraocular complications include retinal artery occlusions and haemorrhages, as well as cotton wool spots caused by complement-mediated thrombotic angiopathy. Neuro-ophthalmological complications including Miller-Fisher syndrome or infarct-related central blindness can also occur in very rare cases. Knowledge of potential transmission routes and personal protective equipment is just as essential for each ophthalmologist as a basic knowledge of potential ocular symptoms and complications.

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“…56 % im Vergleich zum Vorjahreszeitraum, was einer Zahl von 3866 nicht behandel- ten Patienten in 3 Monaten entspricht. Die Frage des Risikos einer Übertragung von SARS-CoV-2 durch Hornhauttransplantation wird weiterführende Untersuchungen erfordern und ist in ihrer Tragweite zum jetzigen Zeitpunkt nur bedingt absehbar [40].…”

Section: Auswirkungen Der Pandemie Auf Ophthalmologische Diagnostik Und Therapienunclassified

Ophthalmic Outpatient and Inpatient Care Under Pandemic Conditions: Hygiene, Triage and New Challenges

Hattenbach

Feltgen

Eter

et al. 2021

Klin Monbl Augenheilkd

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Background The progression of the COVID-19 pandemic has caused significant changes in the environment for outpatient and inpatient care in ophthalmology, with limitations on access to medical care but also new observations and challenges. We now describe major developments in recent months and provide an outlook on the expected consequences. Methods PubMed literature search, clinical survey. Results To date, the course of the COVID-19 pandemic has been characterised by several new but overall rare ocular manifestations, the ophthalmological shared management of COVID-19 patients on intensive care units, and a significant decrease in case numbers, associated with an increase in case severity and relative proportion of emergencies, as a result of delayed presentation of patients and reduced treatment adherence. With the introduction of hygiene measures and infection control procedures, ophthalmic patient care was maintained – including emergencies and urgent treatments. Due to the extensive postponement of elective surgeries, scarce therapeutic and health care professional resources, and the prioritisation of critically ill patients from other specialties, there is a reasonable likelihood that urgent treatments will be delayed as infection rates rise. Conclusion Outpatient and inpatient care in ophthalmology during the COVID-19 pandemic is primarily accompanied by additional organisational or medical challenges and a decline in case volume. Although to date emergency and urgent ophthalmic treatments have been maintained, long-term persistence of pandemic conditions will require additional strategies to provide continuation of ophthalmic care at the required level.

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One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe

Cited by 33 publications

References 28 publications

Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

Ocular Involvement in COVID-19: Conjunctivitis and More

Ophthalmic Outpatient and Inpatient Care Under Pandemic Conditions: Hygiene, Triage and New Challenges

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