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E W CORNEA 9 7 Similar results found for younger and older donor tissue T he results of a 10-year cornea donor study demon- strated that for the majority of corneal transplant pa- tients there is not a differ- ence in outcomes between younger and older donor tissue, despite previous bias against older tissue. T his large study examined more than 1,000 patients to come to this conclusion. Edward J. Holland, MD, direc- tor of the cornea service, Cincinnati Eye Institute, and professor of ophthalmology, University of Cincinnati, and one of the co- principle investigators of the study, discussed the "Ten-Year Results of the Cornea Donor Study," at the 2013 American Academy of Oph- thalmology meeting last fall. This was a prospective study to look at whether or not the age of the donor of the cornea would significantly impact the outcome. "The primary study objective," he said in his pres- entation, "was to determine whether success of a penetrating keratoplasty performed for corneal disease associ- ated with endothelial dysfunction in patients 40 to 80 years old is related to donor age." Prior to the study, there was generally an extreme bias by most surgeons in demanding younger tissue, and as a result, a significant amount of older tissue would not be utilized. The primary study outcome was graft failure, Dr. Holland said. There were several factors associated with lower graft success, including corneal diagnosis of pseudophakic or aphakic corneal edema and a history of glaucoma or glaucoma surgery. The study enrolled 1,101 sub- jects from January 2000 to August 2002 (although 1,090 ended up participating because of 11 being ex- cluded) and involved 105 surgeons at 80 different sites throughout the United States. The mean age of the recipient was 72 years and donors were in the age range of 10 to 75 years. The two donor groups included those from ages 12 to 65 and those from ages 66 to 75. Dr. Holland discussed the results that were tabulated at the 10-year study interval. The implications of the study indicate that there was no signifi- cant difference found in the 10-year success rate when looking at the two donor groups overall. There was, however, a suggestion of a donor age effect at the extremes in the age range, with a slightly higher success rate when corneas were from donors who were ages 12 to 33. Dr. Holland said there was a drastic drop in endothelial cells by the fifth year, and in this drop, there was little difference between older and younger donors. The 10-year results showed a slower rate. "En- dothelial cell loss continued over time, although at a slower rate after the first five years," Dr. Holland said. "Donor age influenced endothelial cell density slightly over the long term." This is a "monumental study," Dr. Holland said. He noted that it has "changed the culture of how we distribute corneas." "Since we observed a fairly con- stant 10-year success rate for donors age 34 to 71, which accounts for the vast majority of donors in the United States, the results indicate that donor age is not an important factor for most penetrating kerato- plasties for endothelial disease," he said. "It truly was the largest study ever done in the field of cornea," Dr. Holland said, noting that it was planned 15 years ago and was origi- nally intended to be just a five-year study. When the study was planned, there was a bias against older donors. It was common for surgeons not to accept tissue from those over age 50, 60, or 65. However, Dr. Holland said that this bias was arbitrary, with no data to indicate that these corneas were any worse than younger donors. "What we found is that at the five-year study point and then 10- y ear study point, the outcomes were the same for younger donors and older donors," Dr. Holland said. "We were thrilled to see that there wasn't a difference." From this data, the general conclusion is that for the vast majority of patients, the age of the donor doesn't matter. Dr. Holland said there were sev- e ral other benefits that came out of the study. Surgeons involved in the study had to accept all tissue offered to them, so this helped to eliminate some of the age bias. In addition, eye banks started sharing more tis- sue to fulfill the surgical needs of the study, which helped to change the way tissue was being distributed in the United States. Initially the success rate at the five-year mark was 86% in both groups, Dr. Holland said, but the study was extended to look at the 10-year results to ensure that no trends were being overlooked. Overall, the 10-year success rate was 75% among all donors. EW EditorsÕ note: Dr. Holland has financial interests with Abbott Medical Optics (Santa Ana, Calif.), Alcon (Fort Worth, Texas), Bausch + Lomb (Rochester, N.Y.), SARcode Bioscience (Brisbane, Calif.), Senju Pharmaceutical (Osaka, Japan), TearScience (Morrisville, N.C.), and WaveTec Vision (Aliso Viejo, Calif.). Contact information Holland: eholland@holprovision.com by Ellen Stodola EyeWorld Staff Writer Ten-year results of cornea donor study March 2014 Penetrating keratoplasty – clear graft at one year Source: Edward J. Holland, MD Boston Fun Fact The 60-story John Hancock Tower contains 13 acres of glass. Source: www.cityofboston.gov 88-107 Cornea_EW March 2014-DL2_Layout 1 3/6/14 3:47 PM Page 97