COVID-19 Transmission Risk in Cornea Transplantation

In 2020, researchers studying COVID-19 transmission identified the virus in conjunctival swabs and tears collected from infected patients.

This finding prompted a study led by Kellogg cornea transplant surgeon Shahzad “Mian, M.D., in conjunction with Eversight Eye Bank and Wayne State University to address COVID-19 related concerns that could impact cornea transplantation. The study was funded by the Eye Bank Association of America (EBAA) through a program targeting issues arising from the spread of COVID-19.

“Since COVID-19 patients hold much of the virus in the upper respiratory tract, we were not surprised that the virus could also contaminate the outer layers of the eye, via coughing, sneezing or hand-to-eye contact,” says Dr. Mian, Kellogg’s Vice Chair for Clinical Sciences and Learning. “Our study focused on the consequences of that finding for cornea transplantation.”

Dr. Mian’s team analyzed postmortem ocular tissue samples from three donor subgroups whose tissues were disqualified from surgical use: 1) intended cornea donors who died from COVID-19; 2) potential donors who were asymptomatic but tested positive at time of corneal recovery; and 3) potential donors who exhibited symptoms prior to death but tested negative for the virus.

Approximately 13 percent of the ocular tissue samples tested positive for COVID-19. The EBAA has thus continued it’s policy of not transplanting cornea tissue that comes from donors with any of these 3 characteristics. The addition of both donor screening and postmortem nasopharyngeal PCR testing for COVID-19 might enable the use of corneas from donors in these subgroups. “With more than 5 million people worldwide losing their sight from corneal disease, we need to do all we can to encourage cornea donation and maximize the global supply of donor tissue.”

Despite the pandemic, Dr. Mian reinforces the safety of cornea transplantation. “Even though cornea tissue can contain the virus, there have been no cases of transmission through corneal transplantation,” he says. “In the rare instances where a donor who was positive for COVID-19 was inadvertently transplanted it has not resulted in infection. Nonetheless, additional research is needed.”