Eye banking is a system of collecting, checking, preserving, and giving donated eye tissue—especially corneas—to surgeons who transplant it into people who have lost vision because their cornea is damaged or cloudy. The cornea is the clear front window of the eye, and when it becomes scarred, thin, infected, or diseased, vision can blur or be lost. Eye banks make sure that the donated tissue is safe, healthy enough, and matched to surgical needs so that transplant surgery works well. Eye banks also protect patients by screening donors to reduce the risk of spreading infections and by carefully evaluating the tissue under strict rules. This organized process helps restore sight for many people around the world. PMC Dove Medical Press EBAA
The eye banking process has several steps: donor screening (medical and social history review to rule out transmissible diseases), tissue recovery (harvesting the cornea within a few hours of death), evaluation (microscopic and microbiological assessment of endothelial cell density, clarity, and contamination), preservation (using media that keep the corneal cells alive for days), and distribution to surgeons. Eye banks follow internationally accepted standards to train staff, certify tissue quality, and track outcomes. These systems include measures to maximize graft survival, minimize infection risk, and ensure ethical consent. PMCEyeWiki
Types of Eye Banking / Eye Bank Categories and Tissue Uses
A. Types of Eye Banks (by structure and operation)
Hospital-based eye banks are run inside or directly linked to hospitals. They can quickly recover donor tissue when a death occurs nearby and often work closely with surgeons. Dove Medical Press
Community or independent eye banks serve a broader population, collecting donations from many locations, processing tissue centrally, and distributing to surgeons in different regions. Dove Medical Press
Regional or national eye bank networks coordinate supply and demand across larger geographic areas. They help balance shortages and distribute tissue where it is most needed. Dove Medical Press
International eye banking collaborations allow tissue sharing across borders when local supply is insufficient; they also help standardize quality in lower-resource settings. Lippincott Journals
B. Types of Donation / Tissue Recovered
Whole eye donation involves recovering the entire eyeball. This is sometimes used for specialized procedures or later dissection; however, for most corneal transplants the corneoscleral disc (the cornea with a rim of adjacent sclera) is excised and processed. EBAA
Corneal (corneoscleral) disc donation is the standard for corneal transplantation; the clear central cornea is used after evaluation. EBAA
C. Types of Surgical Uses / Grafts (which eye banks prepare tissue for)
Penetrating keratoplasty (full-thickness transplant) replaces the entire corneal thickness; the graft is a full-thickness corneal button. EBAA
Anterior lamellar keratoplasty (e.g., DALK / ALK) replaces the front layers of the cornea while leaving deeper layers intact; this uses partial-thickness grafts. EBAA
Endothelial keratoplasty (e.g., DSEK/DSAEK, DMEK) replaces only the inner endothelial layer (and Descemet’s membrane in some types) to treat diseases like Fuchs dystrophy or bullous keratopathy. EBAA
Keratoprosthesis-related tissue is prepared when artificial corneas are implanted; tissue suitability is carefully defined. EBAA
Keratolimbal allograft uses limbal tissue for stem cell deficiency on the ocular surface; eye banks evaluate and prepare these grafts. EBAA
D. Preservation / Storage Methods
Hypothermic storage (short / intermediate term) keeps corneas cold (e.g., in Optisol-GS) for several days and is commonly used in many countries. EBAA
Organ culture (long-term preservation) keeps corneas in nutrient media at warmer temperatures, allowing longer storage and microbial monitoring before transplantation. EBAA
Glycerol or dry preservation is used when sterilized tissue is needed for tectonic or emergency uses and where endothelial viability is not required. EBAA
Cryopreservation or moist chamber for whole eyes is used in some special settings; methods vary depending on intended later use. EBAA
E. Donor and Tissue Evaluation (brief overview)
Eye banks follow formal, evidence-based medical standards to decide if tissue is suitable for transplant. They check clarity under magnification, count and assess endothelial cells (which pump fluid to keep the cornea clear), measure thickness (pachymetry), and determine which surgical use the tissue is appropriate for (e.g., full-thickness vs endothelial). These evaluations are guided by established standards (such as those from the Eye Bank Association of America) and the final decision rests with the transplanting surgeon. EBAA
F. Donor Screening and Safety
Before recovery, donors are carefully screened for infections, certain diseases, and risk factors. Common required serological screenings include HIV, hepatitis B and C, syphilis, and other regionally relevant infections. Eye banks also use antiseptic preparation (e.g., povidone-iodine) on the ocular surface to reduce contamination risk. Processing is done in clean environments to avoid cross-contamination. EBAAPMCEyeWiki
Causes That Lead to the Need for Eye Banking
These are the common diseases and injuries that damage the cornea enough that a transplant may eventually be required:
Bacterial keratitis (infection of the cornea by bacteria) – Bacteria entering the cornea cause ulcers, scarring, and loss of transparency. If not treated early or if severe, permanent scarring leads to blindness. PMC
Fungal keratitis – Fungal organisms (often after trauma with vegetation) invade the cornea; they are harder to treat and commonly leave dense scars. PMC
Viral keratitis (especially herpes simplex virus) – Viruses can cause recurrent inflammation, scarring, and thinning that blur vision over time. PMCCRS Today
Acanthamoeba keratitis – A rare but severe infection usually linked to contact lens misuse; it can destroy corneal tissue leading to transplantation. PMC
Trachoma – Chronic infection causing eyelid scarring and secondary corneal damage (trichiasis) leads to opacity and blindness, especially in low-resource areas. PubMedResearchGate
Chemical burns – Acid or alkali exposures destroy corneal tissue and surface cells, causing scarring, neovascularization, and opaque areas requiring grafts. PubMed
Mechanical trauma – Cuts, scratches, or penetrating injuries can leave scars deep in the cornea that block vision. PubMed
Keratoconus – A thinning and bulging of the cornea that can become advanced enough to require transplantation when vision cannot be corrected with contacts or cross-linking. ScienceDirect
Fuchs endothelial dystrophy – A genetic condition where the inner corneal cells fail, causing swelling, cloudiness, and pain, often needing endothelial grafts. Aetna
Bullous keratopathy – Swelling after surgery (like cataract surgery) or from endothelial failure leads to painful blisters and vision loss, treated with endothelial keratoplasty. Aetna
Autoimmune surface diseases (e.g., ocular cicatricial pemphigoid, Stevens-Johnson syndrome) – These cause chronic inflammation, scarring of surface tissues, and corneal damage that may require specialized grafts. ScienceDirect
Neurotrophic keratopathy – Loss of corneal nerve sensation leads to poor healing, persistent defects, and eventual scarring. ScienceDirect
Vitamin A deficiency (keratomalacia) – A nutritional lack leads to severe drying and melting of the cornea, especially in children in resource-poor settings, causing blindness. DergiPark
Severe dry eye / ocular surface disease – Chronic surface inflammation and ulceration can scar the cornea and degrade vision over time. PMC
Pterygium with deep invasion or recurrence – When a benign growth encroaches onto the cornea significantly or returns after removal, it may cause scarring that distorts vision. ScienceDirect
Corneal degenerations (e.g., band keratopathy) – Calcium or other deposits in corneal layers blur vision; advanced cases may eventually need grafting. ScienceDirect
Post-surgical scarring (failed prior grafts, trauma from refractive surgery) – Previous operations can leave complicated scarring, sometimes requiring repeat or different types of grafts. PMC
Congenital hereditary endothelial dystrophy (CHED) – A birth defect causing early endothelial dysfunction and corneal clouding needing transplant in severe cases. ScienceDirect
Corneal melts from systemic inflammatory diseases (e.g., rheumatoid arthritis) – Autoimmune breakdown of corneal tissue causes thinning, perforation risk, and scarring. ScienceDirect
Congenital infections (e.g., neonatal herpes, toxoplasmosis in eye) – Infections passed before or at birth can scar the cornea early in life, leading to lifelong vision problems. ResearchGate
Symptoms of Corneal Disease That Lead Patients to Seek Care
Blurry or cloudy vision – The cornea’s loss of transparency makes images blurred, like looking through fog. ScienceDirect
Eye pain – Especially in infections or surface breakdown, patients feel sharp or aching discomfort. Medscape
Light sensitivity (photophobia) – Bright light hurts or causes discomfort because the damaged cornea scatters light. PMC
Tearing or watering – Irritation or surface disruption triggers excess tears. PMC
Foreign body sensation – Feeling like something is in the eye due to surface irregularity or abrasion. Jaypee Digital
Red eye – Inflammation from infection, scarring, or surface disease makes the eye look red. PMC
Halos or glare around lights – Light scattering from a rough or swollen cornea causes colored rings or starbursts. ScienceDirect
Vision fluctuation – Swelling or tear film problems cause vision to change from moment to moment. PMC
Reduced night vision – Poor contrast and light scatter make seeing in low light worse. ScienceDirect
Persistent epithelial defects – Areas of the surface that won’t heal cause pain and risk of infection. TVST
Discharge (especially with infection) – Thick, sometimes colored discharge is a sign of active infection damaging the cornea. CRS Today
Scarring visible on exam (patient may notice irregular vision) – Patients often describe “ghosting” or distortion from scars. ScienceDirect
Difficulty wearing contact lenses – Changes in corneal shape or surface make lenses uncomfortable. ScienceDirect
Eyelid swelling or eyelash misdirection causing irritation – Secondary effects from surface disease can further damage the cornea. PubMed
Recurrent episodes of redness and vision decline – Especially in conditions like herpes or autoimmune disease, repeated flare-ups eventually damage tissue. CRS Today
Diagnostic Tests Used to Evaluate Corneal Disease and Suitability for Transplant
The tests are grouped to show how a clinician or eye bank team finds out what is wrong and how serious it is.
A. Physical Examination
Visual acuity testing – Measures how clearly the patient can see at distance and near; baseline for any corneal problem. American Academy of Ophthalmology
External eye examination – Looking at eyelids, lashes, conjunctiva, and surface for redness, swelling, or eyelid disorders that affect the cornea. PMC
Slit lamp biomicroscopy – A special microscope with a focused light beam to look layer by layer at the cornea, tear film, and front of the eye. This finds ulcers, scars, swelling, or infection. PMCJaypee Digital
Pupillary reaction testing – Checks nerve pathways; a serious corneal problem can sometimes mask deeper optic issues or show associated neurologic involvement. American Academy of Ophthalmology
Intraocular pressure measurement (tonometry) – Ensures high pressure or glaucoma is not contributing to visual loss or that inflammatory swelling isn’t compressing structures. American Academy of Ophthalmology
B. Manual / Bedside Functional Tests
Fluorescein staining – A dye highlights surface defects, ulcers, or epithelial breakdown when viewed under blue light; key to diagnosing abrasions and infections. CRS TodayMedscape
Lissamine green or rose bengal staining – Dyes used to detect damaged or dead surface cells, especially in dry eye or chronic surface disease. PMC
Schirmer test – Measures tear production to detect dry eye that can worsen corneal health. PMC
Tear break-up time – Time until the tear film breaks on the cornea; short time means unstable lubrication contributing to surface damage. PMC
Simple corneal sensitivity check (e.g., cotton wisp) – Detects basic sensation loss on the cornea, which can predict poor healing or neurotrophic keratopathy. ScienceDirect
Eyelid eversion and blink assessment – Reveals hidden foreign bodies, trachoma-related lash inversion, or incomplete blinking that threatens corneal health. Jaypee Digital
C. Laboratory and Pathological Tests
Corneal scraping with culture (bacteria/fungi/Acanthamoeba) – Samples from an ulcer are grown to identify the exact pathogen so treatment is targeted. Jaypee DigitalCRS Today
Polymerase chain reaction (PCR) for viral DNA/RNA (e.g., HSV, VZV) – Detects viral causes when the infection is unclear or recurrent; faster and more sensitive than culture for viruses. TVST
Donor serology screening – Blood tests on the donor for HIV, hepatitis B and C, syphilis, and other infections to prevent disease transmission. EBAAEyeWiki
Microbiological testing of stored tissue (contamination checks) – Eye banks culture or otherwise test preserved tissue to ensure no microbial growth before transplant. EBAA
D. Electrodiagnostic Test
Electronic corneal esthesiometry – A machine measures corneal nerve sensitivity precisely (e.g., using Cochet-Bonnet or non-contact devices) to diagnose neurotrophic problems that hinder healing. ScienceDirect
E. Imaging and Specialized Structural Tests
Corneal topography / tomography – Creates a map of the front surface shape; it helps detect keratoconus, irregular astigmatism, and suitability for certain graft shapes. Mount Sinai Eye and Ear
Specular microscopy – Counts and evaluates the health of endothelial cells on the inner cornea, crucial before transplanting because these cells keep the cornea clear. EBAA
Anterior segment optical coherence tomography (AS-OCT) – High-resolution cross-sectional imaging shows how thick the cornea is and the layers involved, helping plan lamellar versus full-thickness surgery. Mount Sinai Eye and Ear
Pachymetry (corneal thickness measurement) – Measures corneal thickness to detect swelling, thinning, or prepare grafts with correct depth, often by ultrasound or OCT. American Academy of Ophthalmology
Non-Pharmacological Treatments
These are therapies or interventions—without systemic drugs—that help protect the cornea, heal the surface, optimize graft survival, or prepare the ocular surface before or after transplant. Each is described with purpose and mechanism in simple terms.
Aggressive Lubrication with Preservative-Free Artificial Tears: Keeping the eye moist reduces friction, supports the epithelium (surface layer), and gives the cornea an environment where it can heal. This is often the first-line approach in surface disorders and graft preparation. NCBI
Autologous Serum Eye Drops: These are made from the patient’s own blood and contain growth factors that closely mimic natural tears. They help heal persistent epithelial defects and improve surface health by supplying vitamins, proteins, and lubricants the damaged cornea needs. PMCPubMed
Bandage Soft Contact Lenses: These thin, therapeutic lenses protect the healing surface, reduce pain, and help keep surface defects covered while epithelial cells regrow. They can also help deliver medication and stabilize graft-host interfaces in high-risk eyes. Cureus
Amniotic Membrane Transplantation: A biological graft with anti-inflammatory and anti-scarring properties, the amniotic membrane is placed on the ocular surface to promote healing, suppress aberrant inflammation, and act as a scaffold for epithelial cells. It is used before or after corneal procedures to improve surface quality. PMC
Limbal Stem Cell Transplantation / Restoration: When the stem cells that renew the corneal surface are damaged, transplanting healthy limbal stem cells from the patient or a donor restores the ability of the cornea to regenerate its surface, preventing persistent defects and rejection-related breakdown. PMC
Eyelid Hygiene and Meibomian Gland Optimization: Cleaning eyelids and managing blepharitis stabilizes the tear film, decreases inflammation, and prevents surface irritation that would compromise grafts or healing. PMC
Punctal Occlusion (Blocking Tear Drainage): Temporary or permanent plugs in tear ducts keep tears on the surface longer, improving lubrication in dry or compromised eyes and thus helping graft-host integration. PMC
Therapeutic (Protective) Eyewear and UV Protection: Shielding the eye from trauma, dust, and ultraviolet light prevents further damage and inflammation; protecting the graft and underlying tissues supports long-term clarity. (General standard of care, implied from ocular surface protection literature.) NCBI
Controlled Eyelid Blinking Exercises: In patients with incomplete blinking or exposure, training correct blinking improves tear spreading and surface moisture, indirectly supporting graft survival. (Inference based on ocular surface dynamics; lubrication importance described in sources about epithelial healing.) NCBI
Environmental Optimization (Humidity, Avoiding Irritants): Reducing airborne irritants, smoke, and dry air minimizes surface stress and inflammation, creating a stable environment for healing. PMC
Mechanical Debridement of Damaged Epithelium (when indicated): Carefully removing unhealthy surface tissue in specific cases can allow newer healthy cells to repopulate, especially before regenerative interventions. ScienceDirect
Use of Therapeutic Scleral Lenses: These large-contact lenses vault over the cornea to maintain a fluid reservoir, protecting the surface in severe dry eye or graft-compromised patients and promoting healing. ScienceDirect
Avoidance of Eye Rubbing and Trauma: Preventing mechanical stress preserves graft sutures and the delicate epithelium, lowering the risk of inflammation or dislocation. (General preventive principle supported by corneal care literature.) NCBI
Optimization of Systemic Disease Control (e.g., Diabetes, Autoimmune): Ensuring systemic conditions are well managed reduces ocular surface inflammation and microvascular stress, thereby improving transplant outcomes. PMC
Use of Protective Ocular Shields During Sleep: These prevent inadvertent rubbing or exposure in vulnerable early postoperative periods, helping the graft remain undisturbed. (Best practice in postoperative care; related to minimizing trauma.) PMC
Surface Cooling or Cold Compresses (selectively): In early inflammation without infection, mild cooling can reduce swelling and discomfort, giving the graft a calmer environment to settle. (Common ophthalmic supportive measure in inflammation.) PMC
Patient Education and Compliance Coaching: Teaching patients how to instill drops correctly, avoid contaminants, and recognize warning signs improves adherence, enhances healing, and reduces failure rates. (Behavioral intervention backed by postoperative outcome studies.) PMC
Use of Temporary Suture Adjustment / Tightening in Early Postop: Proper mechanical support of the graft interface via suture management helps maintain alignment and reduces astigmatism and tension-related rejection triggers. (Surgical aftercare discussed in corneal transplant management literature.) Review of Ophthalmology
Avoiding Preservative-Containing Drops When Possible: Preservatives (like benzalkonium chloride) can irritate the epithelium; using preservative-free formulations limits toxicity and supports graft health. NCBI
Use of Simple Diagnostic Anesthetic Only for Diagnostics: Topical anesthetics should not be used chronically because they can harm the epithelium; this protects surface integrity important for graft and donor tissue interface. PMC
Drug Treatments (Evidence-Based)
These are the most commonly used medications to prevent rejection, infection, or promote graft survival after corneal transplant or manage the ocular surface in high-risk eyes.
Topical Corticosteroids (e.g., Prednisolone Acetate 1%): These suppress the immune reaction that could reject the graft. They are typically started immediately after surgery, tapered slowly over months, and sometimes maintained long-term in high-risk cases. Purpose: reduce inflammation and prevent immune-mediated rejection. Mechanism: inhibit cytokine production and immune cell infiltration. Side effects: elevated intraocular pressure, cataract formation, infection risk increase. PMC
Topical Cyclosporine A (e.g., 0.05% or higher in high-risk eyes): An immunomodulator that reduces chronic inflammation and the risk of graft rejection, especially in patients with ocular surface inflammation or chronic dry eye. Mechanism: inhibits T-cell activation by blocking calcineurin. Used often as adjunct or steroid-sparing agent. Side effects: burning sensation, mild irritation. PMC
Topical Tacrolimus: Used especially in high-risk corneal transplantation to suppress immune-mediated rejection. It’s more potent than cyclosporine in some contexts and works via calcineurin inhibition similar to cyclosporine. Purpose: prevent graft rejection in inflamed or vascularized host beds. Side effects: local irritation, rare systemic absorption concerns. PMC
Topical Broad-Spectrum Antibiotics (e.g., Moxifloxacin 0.5%): Used prophylactically immediately after surgery to prevent bacterial infection at the graft site. Purpose: reduce infection risk during the vulnerable early healing phase. Mechanism: inhibits bacterial DNA gyrase and topoisomerase. Side effects: rare allergic reactions, surface irritation. PMCPMCASTCT Journal
Topical Antiviral Agents (e.g., Acyclovir in Herpetic Disease): In patients with a history of herpetic keratitis, prophylactic oral or topical antiviral drugs reduce risk of reactivation that can compromise grafts. Mechanism: inhibits viral DNA polymerase. Side effects: mild gastrointestinal upset (oral), local irritation (topical). (Standard of care in herpetic high-risk eyes, implied in transplant guidelines.) Wikipedia
Topical Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Occasionally used cautiously in inflammatory control but typically avoided in high-risk grafts if epithelial healing is fragile, because they can slow epithelial repair. Purpose: reduce surface inflammation/pain. Mechanism: COX inhibition reducing prostaglandin synthesis. Side effects: delayed healing, corneal melts if misused. PMC
Topical Lubricants with Hyaluronic Acid: Though not classical “drugs” in rejection prevention, these help maintain ocular surface hydration and support epithelial integrity, indirectly helping graft survival. Mechanism: viscosity and water retention. Side effects: minimal; temporary blurred vision. NCBI
Topical Ganciclovir (or similar) in Viral Surface Disease: For patients with certain viral surface infections or high risk of viral reactivation, using targeted antivirals can protect the cornea before or after grafting. Mechanism: viral DNA synthesis inhibition. Side effects: local irritation. (Inferred from viral keratitis management literature.) Wikipedia
Systemic Immunosuppressants (e.g., Mycophenolate Mofetil in Very High-Risk Cases): Used in selected eyes with repeated rejection or severe immune risk to suppress systemic immune response. Mechanism: inhibits lymphocyte proliferation. Side effects: gastrointestinal upset, increased infection risk. PMC
Topical Antibiotic-Steroid Combination Drops: Used early for convenience to control both infection risk and inflammation, then separated into individual agents for long-term management to better tailor therapy. Purpose: simplify early postoperative regimen. Side effects: combined risks of steroids and antibiotics. (Common clinical practice referenced in corneal transplant aftercare discussions.) Review of Ophthalmology
Dietary Molecular Supplements
These supplements support eye surface health, reduce oxidative stress, and indirectly improve healing and graft tolerance by optimizing the local biochemical environment.
Omega-3 Fatty Acids (Fish Oil, e.g., 1000 mg EPA/DHA daily): Function: reduce ocular surface inflammation and improve tear quality. Mechanism: competes with pro-inflammatory arachidonic acid pathways and produces anti-inflammatory mediators. Dosage: typically 1000–3000 mg combined EPA/DHA per day. Side effects: mild gastrointestinal upset, possible blood thinning at high doses. PMC
Vitamin A (Retinol or Beta-Carotene precursor, e.g., 5,000 IU daily if deficient): Function: essential for epithelial cell health and mucin production. Mechanism: regulates gene expression for surface cell differentiation. Dosage: adjusted based on deficiency; excessive doses should be avoided. Side effects: hypervitaminosis A if overused. NCBI
Vitamin C (Ascorbic Acid, 500–1000 mg daily): Function: collagen synthesis and antioxidant protection for healing. Mechanism: cofactor in hydroxylation reactions needed for stable extracellular matrix and scavenges free radicals. Side effects: GI upset at high doses. PMC
Zinc (e.g., 15–30 mg elemental daily): Function: supports immune regulation and epithelial repair. Mechanism: cofactor in enzymes involved in DNA repair and cell proliferation. Side effects: nausea if taken on empty stomach; high chronic doses can interfere with copper absorption. PMC
Lutein and Zeaxanthin (e.g., 10 mg lutein + 2 mg zeaxanthin daily): Function: antioxidant support for ocular tissues and protection from light-induced oxidative damage. Mechanism: filters blue light and scavenges free radicals in ocular surface cells. Side effects: generally well tolerated. PMC
Vitamin E (Alpha-tocopherol, 200 IU daily): Function: membrane antioxidant to protect surface epithelial cells. Mechanism: prevents lipid peroxidation in cell membranes. Side effects: bleeding risk at very high doses. PMC
N-Acetylcysteine (600 mg daily, orally or as topical formulation when indicated): Function: mucolytic and antioxidant that can improve tear film stability. Mechanism: replenishes glutathione and breaks disulfide bonds in abnormal mucus. Side effects: rare nausea. (Used in ocular surface disease protocols.) NCBI
Bilberry / Anthocyanins (standardized extract, e.g., 80–160 mg daily): Function: antioxidant support and potential microcirculation improvement. Mechanism: scavenges free radicals and may stabilize connective tissue. Side effects: minimal at typical doses. (Supplemental support inferred from ocular antioxidant literature.) PMC
Curcumin (bioavailable formulations, 500 mg twice daily): Function: broad anti-inflammatory and antioxidant support. Mechanism: inhibits NF-κB and other pro-inflammatory pathways. Side effects: GI upset in some; bioavailability issues without enhanced formulations. PMC
Probiotics (specific strains supporting systemic immune balance): Function: supports balanced immune response which may reduce excessive ocular surface inflammation. Mechanism: modulates gut-associated lymphoid tissue and systemic cytokine profiles. Side effects: rare bloating; strain dependent. (Inference from systemic immune-modulation literature relevant to inflammation control.) PMC
Regenerative / “Hard Immunity” / Stem Cell-Related Drugs or Biologics
Cenegermin (Oxervate™) 20 µg/mL Ophthalmic Solution: This is recombinant human nerve growth factor approved for neurotrophic keratitis. Function: promotes corneal nerve regeneration and epithelial healing. Mechanism: binds to NGF receptors on corneal cells and neurons, stimulating survival and repair. Dosage: one drop six times daily for 8 weeks. Side effects: ocular pain, redness, tearing. PubMed
RGTA (ReGeneraTing Agent, e.g., Cacicol): A matrix therapy agent that mimics heparan sulfates in the extracellular matrix, protecting growth factors and promoting tissue regeneration. Function: supports healing in chronic epithelial defects. Mechanism: provides scaffold and protects signaling molecules from degradation. Dosage: as per product instructions (often twice weekly topical application). Side effects: minimal, occasional irritation. ScienceDirect
Topical Platelet-Derived Growth Factor / Platelet-Rich Plasma (PRP) Preparations: Function: provide concentrated natural growth factors to stimulate epithelial and stromal repair. Mechanism: delivers PDGF, TGF-β, and others to damaged tissue, improving cell proliferation. Dosage varies with preparation (often daily or several times per week). Side effects: rare infection if preparation is not sterile. PMC
Cultured Limbal Epithelial Stem Cell Transplants (ex vivo expanded): Though technically a cell therapy rather than a small molecule drug, the biologic product includes cultured stem cells placed onto the ocular surface to restore limbal function. Function: re-establishes healthy epithelial renewal. Mechanism: repopulates the corneal surface with functional stem cells. Dosage/Procedure: one-time transplant, sometimes with repeat if failure. Side effects: graft failure, recurrence if underlying inflammation persists. PMC
Topical Epidermal Growth Factor (EGF) Preparations (experimental/compounded): Function: accelerate epithelial healing in surface defects. Mechanism: stimulates epithelial cell proliferation via EGF receptor activation. Dosage: experimental; usually applied several times daily in clinical trials. Side effects: mild irritation. PMC
Mesenchymal Stem Cell–Derived Secretome or Exosome Preparations (emerging therapy): Function: reduce inflammation and promote regenerative signaling without using whole cells. Mechanism: deliver cytokines and growth factors in vesicles to modulate healing and immune response. Dosage: under investigation, usually topical or perilesional. Side effects: still being characterized; early studies suggest good tolerability. PMC
Surgeries
Penetrating Keratoplasty (Full-Thickness Corneal Transplant): This surgery replaces the entire thickness of the central cornea with donor tissue. It is done when scarring, infection, or disease affects all corneal layers. The surgeon stitches the donor disc into place to restore clarity. Verywell HealthWikipedia
Deep Anterior Lamellar Keratoplasty (DALK): Only the front and middle layers of the cornea are replaced while keeping the patient’s own endothelium. This is done for diseases like keratoconus or stromal scarring when the inner layer is healthy. It reduces rejection risk compared to full-thickness transplant. Verywell Health
Descemet Stripping Automated Endothelial Keratoplasty (DSAEK): This targets the innermost corneal layer (endothelium) and replaces it with donor endothelial tissue. It’s used when the endothelial cells fail (e.g., Fuchs’ dystrophy), allowing faster recovery and less surface disruption. Verywell Health
Descemet Membrane Endothelial Keratoplasty (DMEK): An even more selective endothelial transplant replacing only the Descemet membrane and endothelium. It gives excellent visual outcomes and carries lower rejection risk, but the surgical technique is more delicate. Verywell Health
Keratoprosthesis (e.g., Boston Type I Keratoprosthesis): A synthetic artificial cornea is implanted when donor tissue is likely to fail or has failed repeatedly, such as in severe surface disease or multiple graft rejections. It restores vision by bypassing the host cornea entirely. Postoperative care is lifelong due to risk of complications. Wikipedia
Preventions
Thorough Donor Screening and Tissue Evaluation: Ensures only safe, healthy corneas are used, minimizing transmission of infection or poor graft quality. PMC
Early Treatment of Ocular Surface Infections: Prompt treatment of infections like keratitis prevents scarring that could require transplant. AAO Journal
Protective Eyewear to Prevent Trauma: Avoids mechanical injury that could damage cornea or compromise grafts. PMC
Control of Systemic Diseases (e.g., Diabetes, Autoimmune Conditions): Reduces chronic inflammation and microvascular stress to the eye. PMC
Avoiding Eye Rubbing: Prevents disruption of healing tissue and graft sutures. NCBI
Maintaining Good Lid Hygiene: Prevents blepharitis/ocular surface inflammation that can undermine corneal health. PMC
Vaccinating Against Systemic Infections (where applicable): Reduces risk of systemic illness that could secondarily inflame the eye; e.g., influenza can exacerbate ocular surface stress. (General medical prevention logic.) PMC
Using Preservative-Free Drops When Possible: Limits toxic stress to the surface epithelium. NCBI
Regular Follow-Up After Transplant to Catch Early Rejection: Early detection of redness, loss of vision, or other signs can allow timely intervention. PMC
Patient Education about Warning Signs and Drop Compliance: Empowered patients adhere better to regimens and seek help faster when problems begin. PMC
When to See a Doctor
After corneal transplant or when managing corneal health through eye banking-related care, a patient should immediately see a doctor if they experience any of the following: sudden decrease in vision, eye redness that is worsening, new or increasing pain, sensitivity to light (photophobia), excessive tearing, discharge (especially purulent), a feeling of pressure or fullness, cloudiness over the graft, or signs of graft rejection (pain, photophobia, redness, and drop in vision together). Delayed healing of the corneal surface, persistent foreign body sensation, or sudden floaters with vision changes also warrant prompt evaluation. Early intervention often saves the graft and vision. PMCPMC
What to Eat and What to Avoid (Dietary Guidance)
To support ocular surface health and graft healing, eat foods rich in anti-inflammatory nutrients, antioxidants, and essential cofactors. Good foods include leafy green vegetables (for lutein/zeaxanthin), fatty fish (omega-3s), citrus and berries (vitamin C), nuts and seeds (vitamin E and zinc), and foods with bioavailable zinc (e.g., legumes, whole grains, meat). Staying hydrated supports tear production. Avoid high-sugar diets that can promote systemic inflammation, excessive alcohol which can dehydrate tissues, trans fats and highly processed foods that impair microcirculation, and high sodium in susceptible individuals that may affect vascular health. Smoking should be avoided entirely because it reduces ocular surface oxygenation and increases oxidative stress. PMC
Frequently Asked Questions (FAQs)
What is eye banking and why is it important?
Eye banking collects and preserves donor corneas to restore vision in people with corneal blindness. It ensures safe, high-quality tissue is available for transplantation. PMCWho can donate their corneas?
Most people can donate; age, eye color, or need for glasses usually do not matter. Donors are screened for infectious diseases and corneal quality. EyeWikiHow long can donated corneas be stored?
Depending on the preservation method, corneas can be stored from several days up to about two weeks in specialized storage media before transplant. Verywell HealthWhat are the main types of corneal transplant surgery?
The main types are full-thickness (penetrating keratoplasty), partial-thickness (like DALK), and endothelial transplants (DSAEK/DMEK), plus artificial options like keratoprosthesis. Verywell HealthHow is graft rejection recognized?
Signs include redness, light sensitivity, pain, decreased vision, and tearing. Early detection and treatment are critical. PMCCan rejection be treated?
Yes. Intensifying anti-inflammatory treatment (usually corticosteroids or immunosuppressants) can often reverse early rejection. PMCWhat non-drug steps help graft success?
Good eyelid hygiene, lubrication, avoiding trauma, controlling systemic illness, and patient adherence to postoperative care all help. PMCNCBIAre there supplements that help the eye heal after transplant?
Yes. Omega-3s, vitamins A, C, E, zinc, lutein/zeaxanthin, and antioxidants support healing and reduce inflammation. PMCWhat is cenegermin and when is it used?
Cenegermin is a growth factor eye drop used for neurotrophic keratitis to regenerate nerves and heal persistent defects. PubMedWhat is the difference between DMEK and DSAEK?
Both replace endothelial tissue, but DMEK transplants thinner layers (Descemet membrane + endothelium) for potentially better vision and lower rejection, while DSAEK includes a bit more tissue. Verywell HealthCan someone with dry eye get a corneal transplant?
They can, but the surface needs stabilization first (lubrication, eyelid hygiene, possibly serum drops) to increase the chances of success. NCBIHow long is recovery after corneal transplant?
Initial healing is days to weeks, but full visual recovery and tapering medication can take many months, with long-term follow-up needed. Verywell HealthDo I need to take steroids forever after transplant?
Not always. Many patients taper off after months, but high-risk patients may need long-term low-dose topical steroids to prevent rejection. PMCIs infection a risk after transplant?
Yes. Prophylactic antibiotics immediately after surgery and careful hygiene reduce this risk. Signs of infection should prompt urgent care. PMCAAO JournalWhat happens if the graft fails?
Depending on the reason, repeat transplantation, alternative techniques (like keratoprosthesis), or regenerative therapies may be considered. WikipediaPMC
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Last Updated: August 04, 2025.
