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We read with great interest the article entitled ‘Prevalence of guttae in the graft following corneal transplantation’ by Nahum et al, published in the May 2015 issue of the British Journal of Ophthalmology  . The authors reported the prevalence of cornea guttata postkeratoplasty in a large population of 1116 patients to be 4%. They also found that guttae postkeratoplasty do not negatively affect the visual acuity, endothelial cell density, or graft survival during the initial two postoperative years. The content of this article is important and well put, since this is the first study to reveal the prevalence and sequelae of postkeratoplasty guttae on the corneal graft.
Based on our clinical experience and on multiple published studies, the prevalence of cornea guttata in the normal population is estimated to be higher than 4% . However, the low prevalence reached by Nahum et al, is explained mainly by the preoperative screening of the donor corneas for guttae, as stated in the article. Therefore, it would be very interesting if the authors can provide an estimation of the percentage of donor corneas that are usually discarded by the guttae screening in their eye bank.
Up to our knowledge, guttae are very often not detectable using inverted light microscopy, thus guttae screening as a part of the routine examination of the donor corneas is a challenging task. There is only one study performed by Borderie et al in 2001 , that aimed to detect the pres...
Up to our knowledge, guttae are very often not detectable using inverted light microscopy, thus guttae screening as a part of the routine examination of the donor corneas is a challenging task. There is only one study performed by Borderie et al in 2001 , that aimed to detect the presence of guttae during organ culture. Unfortunately, this study did not clearly describe the features of guttae detected using light microscopy, and the pictures provided did not show specific and distinct findings. Moreover, a clear association proving that the guttae suspected preoperatively in the eye bank correspond to the postoperative guttae detected by specular microscopy was missing.
Therefore, it would be of great importance to the eye banks on an international level to be informed in detail about the preoperative guttae screening process that was performed by Nahum et al, explaining the exact methods followed by their eye bank and clarifying the guttae features as visualized by inverted light microscopy.
1. Nahum Y, Canton V, Ponzin D, Busin M. Prevalence of guttae in the graft following corneal transplantation. Br J Ophthalmol. 2015;99(12):1660-1663.
2. Zoega GM, Arnarsson A, Sasaki H, Söderberg PG, Jonasson F. The 7-year cumulative incidence of cornea guttata and morphological changes in the corneal endothelium in the Reykjavik Eye Study. Acta Ophthalmol. 2013;91(3):212-218.
3. Borderie VM, Sabolic V, Touzeau O, Scheer S, Carvajal-Gonzalez S, Laroche L. Screening human donor corneas during organ culture for the presence of guttae. Br J Ophthalmol. 2001;85(3):272-276.