Cornea. 2026 Feb 2. doi: 10.1097/ICO.0000000000004115. Online ahead of print.
ABSTRACT
PURPOSE: To identify clinical factors influencing corneal endothelial damage during international transportation by evaluating the condition of donor corneas upon arrival in Japan, representing the real-world scenario faced by importing countries.
METHODS: We analyzed 194 donor corneas (from 102 donors; mean age 29.8 years) transported from 3 US eye banks to Japan. All corneas underwent trypan blue staining (0.4%) to quantify endothelial damage, with damaged areas manually traced and analyzed using custom Python-based image analysis. Univariate and multivariate analyses using generalized linear mixed models identified predictors of endothelial damage, with donors stratified into high- and low-damage groups based on median staining rates.
RESULTS: Most corneas (62.4%) showed minimal damage (<2% trypan blue-positive area), whereas 4.1% exhibited extensive damage (>10%). Multivariate analysis identified the following 4 independent predictors of increased endothelial damage: eye bank source (eye bank C vs. A: odds ratio [OR] 4.67, 95% confidence interval [CI] 1.08 to 20.07, P = 0.039), younger donor age (≥31 vs. <31 years: OR 0.40, 95% CI 0.17-0.93, P = 0.033), donor race (Black vs. White: OR 3.44, 95% CI 1.28-9.25, P = 0.014), and cause of death (gastrointestinal disorder vs. cardiovascular disease: OR 4.92, 95% CI 1.35-17.95, P = 0.016; malignant tumor vs. cardiovascular disease: OR 14.32, 95% CI 3.01-68.13, P <0.001). Neither time from death to donation nor preservation duration predicted damage, validating current temporal protocols.
CONCLUSIONS: This study identifies real-world factors influencing endothelial integrity in internationally transported donor corneas, addressing an underrecognized aspect of global eye banking.
PMID:41649845 | DOI:10.1097/ICO.0000000000004115