Cornea and Eye Banking Forum 2023 Scientific Abstracts: Proceedings of the November 2023 Meeting, Cosponsored by the Eye Bank Association of America and the Cornea Society

The annual Cornea & Eye Banking Forum hosted by the Eye Bank Association of American (EBAA) and the Cornea Society is one of the most important and widely recognized scientific meetings in the world for cornea subspecialists and eye bankers. During the 2023 Forum, held on November 3, 2023, in San Francisco, CA, 26 peer-reviewed abstracts were presented. Research from prominent eye institutions and eye banks representing multiple countries around the globe, including the United States., Canada, France, the Netherlands, and India, were included. The abstracts, which are reproduced below, spanned a wide breadth of topics relevant to corneal and ocular surface diseases, keratoplasty, and eye banking and included both clinical and translational studies. Among the clinical studies, outcomes for topical insulin, cenegermin, and sutureless amniotic membrane in treatment of various ocular surface diseases were of notable clinical interest. Several translational studies, such as the study evaluating the potential therapeutic effects of alpha-melanocyte stimulating hormone (α-MSH) in Fuchs dystrophy, highlighted the ongoing development of novel therapies for corneal diseases. Among abstracts specific to keratoplasty research, novel delivery devices for preloaded Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK) as well as clinical outcomes from using cross-linked carrier corneas in Boston Keratoprosthesis surgery were notable topics. Among abstracts specific to eye banking, the development of AI software for measuring endothelial cell density in donor corneal tissue was of particular interest. Big data were also showcased in 3 abstracts that looked at, among other things, corneal transplant practices under the Affordable Care Act and Medicaid. Taken together, the abstracts presented at the 2023 Cornea & Eye Bank Forum represent some of the most cutting-edge technology in corneal transplantation and eye banking. The wide breadth of topics demonstrates the diversity and robustness of research in the cornea and eye banking community. Joshua Hou, MD Scientific Program Chair, EBAA, Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN Sophie Deng, MD, PhD Scientific Program Chair, Cornea Society, Cornea Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA Insulin for Treatment of Neurotrophic Ulcers: Clinical Evidence and Potential Mechanism Victoria Zeisberg, MD,* Univeristy of Erlangen Medical School Co-Authors: Matthias Zenkel, PhD; Andreas Giessl; Ursula Schlötzer-Schrehardt, PhD; Theofilos Tourtas, MD; Julia M. Weller, MD; Victor A. Augustin, MD; and Friedrich E. Kruse, MD Purpose: Neurotrophic keratopathy causing non-healing epithelial defects represents a significant clinical challenge. Besides nerve growth factor, insulin has been shown to be a promising therapeutic agent promoting epithelial wound healing, but proper dosing and cellular mechanisms have not been clarified. In this study, we substantiated clinical use of insulin for the treatment of refractory neurotrophic corneal ulcers in vivo and investigated potential cellular mechanisms underlying re-epithelialization of corneal epithelial wounds in vitro. Methods: In a retrospective, single-center case series, the outcomes of 20 eyes of 20 patients treated with topical insulin eye drops (25 U/mL at differing intervals) for neurotrophic corneal ulcers, refractory for conservative treatment, were analyzed. Corneal epithelial wound closure was monitored daily. Human primary limbal epithelial cells were incubated in serum-free medium without or with different concentrations (0.05–150 µg/mL) of insulin for 24 hours. Gene expression profiles were analyzed using the Human Wound Healing PCR array and verified using specific real-time PCR assays and immunocytochemistry. The influence of insulin on cell migration and proliferation was assessed using appropriate assays. Results: Complete corneal re-epithelialization was observed in all 20 eyes (100%) following insulin standard treatment regimens (25 U/mL = 0.5 U/drop QID). Higher doses did not enhance outcome but appeared to induce corneal angiogenesis. Experimental analyses provided evidence for a significant dose-dependent effect of insulin on epithelial migration, with lower doses (0.5–1.0 µg/mL) being most effective. Expression profiling studies revealed significant upregulation of genes involved in cell migration (e.g., FSCN2, TSPAN1) and downregulation of cell adhesion molecules, including integrin subunits and ICAM1, upon exposure to 1.0–5.0 µg/mL insulin. However, higher doses (50–150 µg/mL) induced a 2.5-fold upregulation of VEGFA (vascular endothelial growth factor A). Conclusion: The findings confirm previous studies on a beneficial effect of topical insulin on corneal epithelial wound healing following standard treatment regimens. At lower doses, insulin stimulates corneal epithelial cell migration by coordinated effects on cell detachment and increased motility, whereas higher doses appear to induce angiogenesis. These findings may have important implications in treating neurotrophic keratopathy and epithelial wound healing defects. Outcome of Cenegermin in the Treatment of Neurotrophic Keratopathy Across Various Causes Golshan Latifi, MD,† Stein Eye institute, University of California, Los Angeles Co-Authors: Piseth Dalin Chea, MD; Saba Al-Hashimi, MD; Reza Ghaffari, MD; Anthony J. Aldave, MD; Sophie Deng, MD, PhD; and Simon S. M. Fung, MD Purpose: To assess the efficacy of cenegermin in treating patients with neurotrophic keratopathy (NK) resulting from various causes. Methods: This study is a retrospective, consecutive case series that reviewed the medical records of patients who received cenegermin 20 μg/mL for at least one course of 8 consecutive weeks at Jules Stein Eye Institute between February 2019 and April 2023. All the patients included in the study had reduced corneal sensation and had previously shown inadequate responses to conventional medical therapies for at least 2 weeks. Data, including demographic information, underlying etiology, stage (Makie classification), and clinical characteristics of NK at baseline and 8 weeks, were collected. The primary outcome was the improvement in NK, defined as a decrease in epithelial defect (ED) size, if present, or in surface areas of epitheliopathy if ED was not present at 8 weeks. Results: Forty-three eyes of 43 patients (26 females, 17 males, mean age 64.1 ± 18.56 years) were enrolled in this study. The primary etiology for NK was severe dry eye in 2 (4.6%), exposure keratopathy in 5 (11.6%), limbal stem cell deficiency (LSCD) in 13 (30.2%), and primary NK in 23 (53.5%) patients. At week 8, NK improved in 29 (67.4%) patients, did not significantly change in 7 (16.3%), and worsened in 7 (16.3%). The percentage of eyes that improved at 8 weeks was significantly higher in the primary NK group compared with LSCD (82.6% vs. 53.8%, = patients with a mean to of weeks patients received a course of cenegermin in At 8 weeks of the patients 2 significant and Conclusion: Cenegermin in treating NK with various observed a significantly higher efficacy in primary NK compared with In patients treatment, NK was by other such as dry or Cenegermin not appear to to for and Corneal of to of Care MD, of Eye Bank Co-Authors: PhD; MD; and Purpose: To efficacy and of a corneal for treating and corneal Methods: corneal were in 20 corneas ± by a donor cornea on the corneal with a and the by with a = was treated with and a from a standard of group 2 = was treated with CA and a which was with a from a corneal to in with a from the 3 = the treatment as group the were using a All of the treated were to using a in series to the and a Results: All in group 3 held the by the without was and most in group 3, by group and the in group ± 17 vs. ± vs. ± of Conclusion: with higher and the corneal with of this at least without to studies assess at the in of in MD, Boston Medical Co-Authors: MD; MD; S. MD; MD; MD; and MD, Purpose: To the and of a for amniotic membrane transplantation with a one in the of Methods: This study all patients with from to a who received in the to and had at least one in the outcomes included at the most of a severe ocular by to and of was to the of potential on Results: of 23 patients were patients in the group and patients in the was between the 2 in at the most = or development of a = The was in the The that was in at the most between patients who had received versus = Conclusion: The for is as as the in the ocular surface and ocular in is in and be in patients. of Corneal of Corneal for the Boston Keratoprosthesis Eye and Co-Authors: M. MD; MD; MD; and Purpose: To the effect of corneal on corneal between eyes that were to or donor corneas as the carrier tissue for Boston Keratoprosthesis Methods: retrospective, of from at weeks and from the eyes of that were to or carrier tissue for donor corneas were to donor corneas that vivo or were The of corneas that were for were included in the The were analyzed using a on and software of The 2 primary to were defined as the of corneal the of a and defined as the of corneal in which are and were for Results: on the the percentage of is lower in the compared with the group as the effects of the percentage of the by = is of in the percentage of in the compared with the group = Conclusion: This study the to be lower in donor corneas the that the of donor corneas may to The of vivo of donor corneas in to be studies to of Corneal During in Corneal for Julia Eye Co-Authors: MD; and Purpose: To the of corneal induced by in patients with corneal Methods: patients with with a corneal of were of corneal and were epithelial with was in a At the of the all eyes were to a was to induce is was at epithelial epithelial of baseline to and of Corneal was using Results: of eyes from patients were ± the mean baseline was ± and was ± in a mean of ± and the mean was All eyes a of was ± baseline was with a of corneal or endothelial cell density had effect on the of corneal Conclusion: all eyes with baseline were to at least to In we a mean of and observed this to be on baseline This for a of in patients with corneas who be from conventional Corneal Friedrich Kruse, of Erlangen Medical School Co-Authors: Andreas PhD; Matthias Zenkel, PhD; Theofilos Tourtas, MD; Victoria Zeisberg, MD; Julia M. Weller, MD; MD; and Ursula Schlötzer-Schrehardt, PhD Purpose: The use of topical for the treatment of corneal endothelial is but various ocular effects including epithelial topical have been The mechanisms of development are but effects on corneal epithelial cell we analyzed the effects of and on cell adhesion and of corneal epithelial and endothelial cells in vitro. Methods: corneal endothelial and epithelial cells were incubated with and and for to 7 Gene and expression analyses were by real-time PCR assays and immunocytochemistry. assays assessed cell migration, proliferation and for Results: In corneal endothelial both and significantly cell proliferation and migration and improved and compared with induced significant upregulation of genes and to and including and effects of both were observed on expression of corneal epithelial cell expression of and genes were by were not or by with a in epithelial Expression upon of on Conclusion: The findings that both and corneal endothelial cell but effects on corneal epithelial cell and epithelial the use of may be by but effects on corneal epithelial and membrane of on Corneal of School of Co-Authors: Purpose: To corneal donor endothelial cell density and transplant Methods: This study corneal donor transplant from the eye between and of to cell and for transplantation data were for corneal was to of for of were using using both a outcome and a outcome cell were for both transplant and endothelial cell density with and to the of to the Results: of were were which were reduced to the most transplant the of for 2 of the Across all of and use appeared in the of use of donor and of the most to the transplant endothelial cell was the of in 3 of the were among the of use and of Conclusion: In a of corneal donor was as the most to for corneal donor transplant and endothelial cell novel with corneal donor tissue that may study. of Corneal to the and Potential of Corneal Co-Authors: MD; and MD Purpose: corneal the to or the of various corneal of the are with for the of eye banking and corneal transplantation including is for the development of corneal The of study is to the effect of corneal and novel on and and potential of corneal endothelial cells and limbal epithelial stem cells Methods: the effect of of in corneal and corneas were in a medium without and with from research and were by a group of on 3, and The endothelial cell density of percentage and corneal were of on migration and proliferation was using the vivo The effect of corneal practices on of was also using Results: data demonstrates that of to corneal significantly the of corneal observed that the of decrease and from to 3 was reduced in the corneal medium with compared with the a medium with was to the by compared with in the group vivo of on 7 was in the and in the under Conclusion: Taken together, studies that of be beneficial to of corneal and are not to of that eye banks and using for and to the transplantation of from donor and to the of Cornea University Co-Authors: PhD; S. PhD; PhD; PhD; MD; and Purpose: a for endothelial cell and density of donor cornea Methods: eye donor were with and with eye without were in 2 and not for on was using a of the with the for The a which was on Results: from and to cells a eye of to cells The mean between eye and automated was and These are significant but not and of automated of eye significant in between the 2 = Conclusion: of donor and of Fuchs Corneal MD, and University Co-Authors: PhD; MD, PhD; and MD, PhD Purpose: data from and from patients with Fuchs endothelial corneal to and to endothelial keratoplasty Methods: was at for patients with and and at for patients with from was epithelial and and were and the standard of was Results: compared with = eyes = significant in the of cornea and and had mean vs. eyes = had a of epithelial vs. = eyes = significant in corneal = and = compared with and were not significantly different between eyes and vs. = Conclusion: eyes have in and increased compared with eyes have a of epithelial and eyes that of and improvement in of These may to the of versus Potential of the in Fuchs Eye Research Institute Co-Authors: MD, Reza MD, PhD; MD, PhD; MD; and MD Purpose: To the therapeutic potential of alpha-melanocyte stimulating hormone (α-MSH) in induced corneal endothelial using a of Fuchs endothelial corneal Methods: were to of on the cornea to induce and received treatment exposure or 2 weeks exposure Corneal endothelial cell density and were analyzed in vivo corneal was by and cell were assessed in cells treated with and using and Results: significantly reduced induced by in corneal endothelial cells also endothelial cell and challenge. In a of Fuchs dystrophy, treatment on exposure corneal endothelial cell density to baseline treatment 2 weeks exposure endothelial cell At 3 both and treatment with the in corneal observed in corneas corneal Conclusion: demonstrates therapeutic potential in development of the Fuchs of as a corneal endothelial of Human in Eye Institute Co-Authors: and Purpose: To the ocular surface of eyes of for Methods: eye with from eye 24 of the and of the ocular with were of the by PCR of the was were to the standard using a for were using a with a of of the of were from and diversity and were for measuring and of the using and Results: reviewed the of donor with was included. The of observed was of was at the and The were and 3 were and were and Conclusion: revealed to be the on the ocular surface 24 hours. is the and were also in Corneal in the University School of Co-Authors: MD; MD, and A. MD, Purpose: studies have in to and of corneal received by and studies have assessed corneal transplant in the The of study was to of corneal in patients and assess for or Methods: This was a using data to different of corneal transplant from to Corneal transplant including keratoplasty endothelial keratoplasty and keratoplasty were by of age with as a primary or who received a corneal transplant the study were included. characteristics were from demographic and the among versus was also Results: analyzed corneal on from to of all were on patients and The most of were by The of patients were most patients were patients were received of all in the study of of patients as as as as and as were least in areas and the of of all patients in data were by and had and of of the with the we that patients a of the and patients and of and of patients were Conclusion: the of in the United most in the from to were patients were by a of patients corneal research to and in corneal transplantation are and of Cornea the Affordable Care Eye Institute Co-Authors: MD; MD; MD; PhD; and MD Purpose: To the and of corneal transplant patients among the Affordable Care Act data Methods: and were to assess and using data and Results: Among = corneal of the patients were from the = and enrolled in the = corneal was the primary transplant = patients endothelial keratoplasty, keratoplasty keratoplasty and = of patients a The most were corneal transplant and surgery or one transplant was with increased of and but not corneal transplant = was not with of = with a had the with a had the Conclusion: This study is the to assess the and of corneal transplant patients the and of in Corneal University Co-Authors: MD; MD; and MD Purpose: To demographic with of in patients for the of corneal ulcers in the United Methods: study of patients years) with a primary of corneal in the United between and was using data from the were 2 on compared with the medium of the and for were by Results: of patients were included for The had a higher of the group ± vs. ± with were American = and Medical included use = = = and = on corneal ulcers are to have a annual of in the United Conclusion: Corneal represent a significant of for patients as well as This study which may to patients most to and to corneal to the Descemet or Joshua Co-Authors: M. and PhD Purpose: To the and of preloaded Descemet stripping automated endothelial keratoplasty (DSAEK) in a for Methods: were by the were to to and by and to did not were to and preloaded a was to the of the and the preloaded were were the and analyzed using and cell was compared with a preloaded in the for the Results: for the preloaded and was ± and with the = with of ± = were 3 be with for as well as Conclusion: The be to the of a to be for this did not the to use the for The provided by this potential to eye banks and the and for Descemet without or MD, Institute Co-Authors: and MD Purpose: Descemet membrane endothelial keratoplasty (DMEK) the in and a of or to The of this study as to a novel carrier and to preloaded in the using a without of Methods: novel carrier was with eye with but for a the the is held with and compared the endothelial of 8 corneal preloaded the carrier for 24 = and = and to a with and using were in and endothelial were using and with areas assessed by were with Results: The the carrier was observed All were a are by without observed and without or other areas of 24 and preloaded were endothelial cell density being preloaded was not significantly different compared at 24 and Conclusion: novel carrier of preloaded and in and delivery by in with cell Clinical for Descemet Descemet in with Eye Institute Co-Authors: MD; J. MD; and A. MD Purpose: To the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with a or Methods: of and in eyes with a or was primary and endothelial cell were Results: eyes were in the group and eyes in the for and was versus = was and in the and = and was and in the group and and in the = and = Conclusion: was a significantly lower and in the The significant in and in for may be to the of the of Corneal Corneal MD,† The for of Co-Authors: MD; and MD, Purpose: To the outcomes of corneal transplantation following corneal in patients. Methods: Medical records of all with neurotrophic keratopathy who corneal with nerve by corneal transplantation between and were reviewed included demographic information, ocular corneal by and Results: eyes which corneal corneal transplant age years) corneal transplantation was was observed in all eyes by was keratoplasty was in 2 and keratoplasty in at the was improvement was observed in from baseline to = Conclusion: corneal transplantation following corneal has and be in patients who have not previous may improvement in may be by of on Descemet and MD,† Eye Institute Co-Authors: J. MD; MD; and A. MD Purpose: To the in Descemet membrane endothelial keratoplasty (DMEK) who use at the versus use the was to if use has influence on endothelial cell at the Methods: of eyes for Fuchs was in the 2 were who drops the were compared with patients who on drops the for and with such as previous or were Results: was versus in group = for was ± = and group 2 was ± = = of the eyes with a a to the in the 2 Conclusion: was significant in or between use for 2 did not influence endothelial cell most patients, is to use be to the of the the of Corneal Reza MD, Eye and Medical School Co-Authors: MD; MD; and MD Purpose: is in at The of study was to in and of cells in vs. and if the of donor Methods: or and 2 were as and as of = and endothelial = was to assess was to assess cell assays were to assess of Results: was with a significant in of corneal cells with and that received or donor tissue significantly increased = and insulin treatment in to a significantly lower = and higher in both and Conclusion: and in corneal cell the tissue and the of for both and Clinical and of and Eye Bank in Eye Institute Co-Authors: PhD; and Purpose: To the clinical and donor characteristics of at eye in Methods: of from to During this donor corneas were for keratoplasty endothelial and keratoplasty The the weeks of keratoplasty were analyzed for Results: During the a of 43 had The of the were Descemet stripping automated endothelial keratoplasty, and 3 Descemet membrane endothelial 2 keratoplasty, and 8 The clinical was in eyes and with in 23 The were in in in in and in 13 All the were to In all the donor corneas were from The of donor was following in in in and in The mean of was The to was Conclusion: The of from to of the were following of which Descemet stripping endothelial keratoplasty was the most of the and Anthony J. Aldave, Eye Institute, University of California, Los Angeles Co-Authors: MD, PhD; MD; MD; MD; MD; and MD, PhD Purpose: To a previously corneal endothelial with corneal endothelial and corneal Methods: and from 7 previously a The of endothelial was on the of in the corneal or Descemet endothelial and corneal was in 3 and of was in all of Descemet membrane at the of endothelial keratoplasty was for 3 were in of Results: of the from 7 who were were as from endothelial keratoplasty, resulting in the of corneal revealed a in the in from 3 and in the with a or in from the other the the novel has been with corneal both and have The of was increased in and but was not in the of Conclusion: novel corneal endothelial by corneal and endothelial without is with and in the endothelial to this that may be with endothelial in with Corneal and Medical Co-Authors: MD; and MD Purpose: To potential in patients with corneal and of Methods: This study patients at Eye between and with were included if were had and had a of or were for multiple or Results: The of the patients included ± years) were and of or of patients for a or The most were and The most were and Conclusion: and such as and as well as and are observed in patients with a of in a group with surgery as These may be to a to patients at of following Corneal and are in MD, Eye Institute, University of California, Los Angeles Co-Authors: and Sophie Deng, MD, PhD Purpose: To corneal sensation and nerve in eyes with limbal stem cell deficiency Methods: This study was by the and was to the of eyes with LSCD and eyes were between 2019 and The corneal sensation was by and nerve was at the cornea and limbal and using in vivo of nerve nerve density and nerve and density were using University of by 2 The of LSCD was using a previously including clinical corneal epithelial and corneal cell of was defined as stage between 5 and as stage and as stage analyses were using the and Results: and eyes were as stage and The mean sensation at the cornea and were and in the LSCD group and and in the group All of nerve were significantly at the and limbal in the LSCD group compared with the The corneal and limbal sensation had with the LSCD = and had with = and = Conclusion: Corneal and are reduced in LSCD at both corneal and limbal The of corneal and limbal sensation had a with the in and the of This study the keratopathy in the of

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