A careful history of any previous ocular surgery should undoubtedly be one of the most useful ways to know if the donor had undergone any refractive surgery. Wolf et al. have reported a case where a mention of a history of laser treatment prompted the authors to look for a LASIK flap in donor cornea on optical coherence tomography.11 This may, however, be missed by the eye bank team as well as the relatives of the deceased. Furthermore, a normal sit-lamp examination and endothelial cell counts cannot rule out previous refractive surgery. It was definitely easier to spot radial keratotomy cuts on the surface of donor corneas in the past as compared to now when most cases undergo advanced surface ablation or a thin-flap LASIK. The difference in corneal thickness measurements in central and peripheral cornea may provide some evidence in support of a previous refractive surgery procedure. ASOCT seems to a promising technique as evidenced by the past and recent literature.13 It would be prudent to improve the techniques of ultra-high-resolution ASOCT so that the LASIK flap interface can be detected even with variable storage media and storage times that are being used in different eye banks around the world. This would potentially cost a lot more in terms of money and manpower. Also, if such a practice has to be implemented, the eye bank technicians would need training from clinicians to use the ASOCT for donor screening.
Rasik B. Vajpayee
The authors declare no proprietary/financial interests, financial disclosures, or conflict of interest in any products/techniques mentioned in the text.
Received October 8, 2013; accepted October 21, 2013.
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