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Corneal transplantation in the aftermath of the COVID-19 pandemic: an international perspective
  1. Marcus Ang1,2,3,
  2. Aline Moriyama4,5,
  3. Kathryn Colby6,
  4. Gerard Sutton7,8,
  5. Lingyi Liang9,
  6. Namrata Sharma10,
  7. Jesper Hjortdal11,
  8. Dennis Shun Chiu Lam12,13,
  9. Geraint P Williams14,15,
  10. John Armitage16,
  11. Jodhbir S Mehta1,2,3
  1. 1 Singapore National Eye Centre, Singapore
  2. 2 Singapore Eye Research Institute, Singapore
  3. 3 Duke-NUS Medical School, National University of Singapore, Singapore
  4. 4 Sorocaba Eye Bank, Brazil
  5. 5 Federal University of São Paulo, Brazil
  6. 6 University of Chicago, Chicago, IL, USA
  7. 7 Save Sight Institute, University of Sydney, Australia
  8. 8 New South Wales Eye & Tissue Bank, Australia
  9. 9 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, China
  10. 10 Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, India
  11. 11 The Danish Cornea Bank, Ophthalmology, Aarhus University Hospital, Denmark
  12. 12 C-MER Dennis Lam Eye Center, C-MER International Eye Care Group Limited, Hong Kong, China
  13. 13 International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), China
  14. 14 Worcestershire Acute Hospitals NHS Trust, United Kingdom
  15. 15 University of Birmingham, United Kingdom
  16. 16 Bristol Eye Hospital, Bristol, United Kingdom
  1. Correspondence to Jodhbir Mehta, Singapore National Eye Centre, Singapore, Singapore; jodmehta{at}gmail.com

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Corneal blindness is the third leading cause of blindness worldwide.1 Corneal transplantation remains the only method of restoring vision in eyes with end-stage corneal decompensation and is the most frequently performed type of transplant worldwide.2 Due to the immunological and lymphogenic privilege of the avascular cornea, keratoplasty is the most successful tissue transplantation procedure currently performed in humans.3 However, as with most solid-organ transplants, the risk of transmitting infectious diseases and viruses is an important aspect of corneal transplantation that can affect recipients or those handling donor tissue.4 Thus, the rapid emergence of a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since December 2019 has led to a devastating impact on corneal transplantation worldwide.

To date, the SARS-CoV-2 has infected close to 13 million people and led to  more than 560000 deaths worldwide in a short space of 6 months (WHO COVID-2019 situation report as of July 13, 2020). Since its emergence in Wuhan China, the SARS-CoV-2 has been reported to cause conjunctivitis and detected in tears or conjunctival secretions.5 The potential for SARS-CoV-2 to affect the ocular surface had immediate implications for eye banking around the world. Furthermore, travel restrictions and curtailed elective procedures have led to the reduction in the supply, retrieval and demand for corneal transplantation.6 Thus, the future of corneal transplantation faces an unprecedented threat, as access to this sight-restoring surgery is affected on a global scale.7 Beyond the pandemic, COVID-19 may have lasting effects on corneal transplantation, as healthcare services resume to face long waiting lists and a potential shortage of donors. Therefore, there is an urgent need for a consensus on recommendations for restoring corneal transplantation services, even as the outbreak evolves and we learn more about the SARS-CoV-2.

OCULAR TRANSMISSION OF SARS-COV-2

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