title: The grave necessity to make eye bank specular microscopy mandatory in all eye banks in the subcontinent to improve utilization of scarce donor corneas.
abstract: BACKGROUND
  Donor tissue scarcity, Eye Bank Specular Microscopy as yet not made mandatory and tissue utilization often based on clinical judgment only.
  
  
  OBJECTIVE
  Prospectively analyze alteration in clinical grading of donor corneas and hence utilization, based on Eye Bank Specular Microscopy (EBSM) and to infer if EBSM should be mandatory in all eye banks.
  
  
  METHODS
  200 consecutive otherwise 'suitable for surgery' donor eyes were graded clinically. On quantitative and qualitative analysis of endothelial cells by EBSM, final grading was adjusted. Impact on subsequent utilization for various surgeries was analyzed with regard to Age of Donor, Death to Enucleation Time, Death to Preservation Time and Lens Status of Donor Eye.
  
  
  RESULTS
  76 eyes (38%) (P < 0.05) had significant change in grading. 12/59 (20.30%) tissues from donors <=40 years showed Cell Density (CD) between 1801-2500. 19/76 (25%) tissues from donor >60 years showed CD >= 2500. From donor >=81 years, 2/13 (15.3%) eyes showed CD between 2501-3000 and 1 (7.6%) eye showed CD > 3000. Owing to better grading after EBSM, 13/14 (92.85%) tissues with DTET >6 hours and 5/5 (100%) tissues with DTPT > 16 hours were transplanted. Out of 45 (22.5%) pseudo-phakic tissues, 21 (46.67%) tissues were used for Therapeutic/Tectonic Penetrating Keratoplasty (PKP) while 24 (53.33%) tissues were used for Optical PKP.
  
  
  CONCLUSIONS
  EBSM significantly alters final grading of tissues and its subsequent utilization. Acquiring huge importance in areas where adequate supply of corneas is lacking, EBSM becomes an indispensable tool for optimizing availability of qualified tissues for surgery. EBSM should be made a mandatory analysis.
authors.affiliation: M and J West Zone Regional Institute of Ophthalmology, BJ Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
authors.forename: Jagruti N
authors.initials: JN
authors.lastname: Jadeja
authors.forename: Bharati D
authors.initials: BD
authors.lastname: Patel
authors.forename: Swapna S
authors.initials: SS
authors.lastname: Shanbhag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000166:cytology* / Q000000981:diagnostic imaging; D016039:Corneal Transplantation / Q000592:standards / Q000706:statistics & numerical data*; D005125:Eye Banks / Q000458:organization & administration*; D006801:Humans; D007194:India; D037141:Mandatory Programs / Q000706:statistics & numerical data*; D033401:Microscopy, Acoustic / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult