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Reduction of Donor Cornea Exposure to Repeat Warming Cycles and Evaluation Times After Implementation of a Rapid Warming Protocol

Clover, Jameson, CEBT*; Ansin, Amy, BS*; Stoeger, Christopher G., MBA, CEBT*; Terry, Mark A., MD*,†; Tran, Khoa D., PhD*

doi: 10.1097/ICO.0000000000001583
Clinical Science

Purpose: To compare tissue evaluation times and specular image quality before and after the implementation of rapid tissue warming at a single eye bank.

Methods: This retrospective study compares the evaluation of 494 donor corneas. All corneas were stored in Optisol-GS. Group 1 contained 247 corneas evaluated immediately before implementation of a tissue incubator and tissue warming protocol. Group 2 contained 247 corneas evaluated immediately after implementation. Total evaluation times (including specular microscopy, optical coherence tomography for corneal thickness measurements, and 2 slit-lamp examinations) were calculated and compared. Representative specular images of donor corneas were rated and compared using a previously described scale by 2 masked readers.

Results: Donor tissue characteristics were not significantly different between both groups (age, P = 0.87; sex, P = 0.93; endothelial cell densities, P = 0.47; and death-to-preservation times, P = 0.18). The mean total evaluation time for group 2 corneas was ∼3 hours, with 97% (201/208) of evaluations completed on the same day. In contrast, only 73% (164/225) of corneas from group 1 were completely evaluated in 1 day, and the mean evaluation time for those corneas was ∼4.25 hours (P < 0.01). Specular images of corneas from group 2 were rated 1 grade higher, on average, than those from group 1 (n = 247 in each group, P < 0.01). Furthermore, 71% of specular images from group 2 were categorized as “good” or “excellent” quality, whereas only 30% of corneas from group 1 received those ratings.

Conclusions: Rapid tissue warming cuts down on tissue evaluation time and reduces the time donor corneas are out of cold storage. Better specular images were obtained after implementation of the rapid warming protocol.

*Vision Research Laboratory, Lions VisionGift, Portland, OR; and

Cornea Services, Devers Eye Institute, Portland, OR.

Correspondence: Khoa D. Tran, PhD, Vision Research Laboratory, Lions VisionGift, 2201 SE 11th Avenue, Portland, OR 97214 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received December 05, 2017

Received in revised form February 03, 2018

Accepted February 06, 2018

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