NTERIOR SEGMENT
EYE BANKING
COVID-19 and the Great Cornea Bank Stickup by Sam McCommon
T
hat eye banking was hit by the COVID-19 pandemic perhaps won’t come as a shock to most people. Indeed, we’re all painfully aware of just how much it turned the world upside down, so we needn’t further belabor that point. If we can imagine the eye bank as a dusty, small-town deposit bank and the virus as a masked, gun-slinging robber — well, that’s not far off. The eye banking system in general deserves a closer look vis à vis the virus because there are still some unanswered questions. So, the All India Ophthalmological Society (AIOS) during its first International Ophthalmic Conclave (IOC), or AIOS IOC 2021, turned to Dr. Jennifer Li, professor of ophthalmology and vision sciences at the University of California at Davis and chair of the Medical Advisory Board at the Eye Bank Association of America (EBAA) to shed some light on the situation.
Sand in the gears It’s an unusual virus we’re dealing with, to be sure, and extreme caution in eye banking has been the go-to rule. This extreme caution led to what was essentially a complete, worldwide collapse of cornea transplants in March and April of 2020. Just to make that clear, there were for all practical purposes no cornea transplants during that period. That’s unprecedented — another word we’re all likely sick of by now.
international eye banks lag behind. It’s great to see the eye bank world spring back to life, but it’ll take some time before things are running as smoothly as before. We’re not out of the woods yet, anyway. Just to chart a clear path through said woods so we don’t get lost, let’s take a quick step back and see how we got to that collapse and then how things have progressed from there.
Sticky stuff
As Dr. Li noted, U.S. eye banks have recovered to around 80% to 85% of their pre-COVID levels, though
Early on in the pandemic, information on just how the virus affected the eyes was scarce. We’ve come a long way,
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| March/April 2021
however. The virus behind the pandemic is well known to bind to angiotensin converting enzyme 2 (ACE2) receptors most notably, but others as well. The ACE2 receptor is present in the conjunctiva, limbus and cornea, as are TMPRSS2 and DC-SIGN/DC-SIGNR. Dr. Li pointed out that TMPRSS2 can allow the virus to enter a cell after it’s bound to an ACE2 receptor via its spike protein. Alternatively, the DC-SIGN/DCSIGNR could be another transmission method for the virus. So we know that the virus can infect ocular tissue. That’s the bad news. The good news is that it doesn’t appear to be able to replicate in ocular tissue, or
