Year : 2019 | Volume
: 67 | Issue : 10 | Page : 1584--1585
Commentary: Comparison of structural integrity and functional status of corneal endothelium stored in Cornisol and Optisol-GS
Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
Dr. Prema Padmanabhan
Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai - 600 006, Tamil Nadu
|How to cite this article:|
Padmanabhan P. Commentary: Comparison of structural integrity and functional status of corneal endothelium stored in Cornisol and Optisol-GS.Indian J Ophthalmol 2019;67:1584-1585
|How to cite this URL:|
Padmanabhan P. Commentary: Comparison of structural integrity and functional status of corneal endothelium stored in Cornisol and Optisol-GS. Indian J Ophthalmol [serial online] 2019 [cited 2020 Aug 12 ];67:1584-1585
Available from: http://www.ijo.in/text.asp?2019/67/10/1584/267373
“Make in India”—A Challenge Accepted!
Corneal transplantation as we enjoy it today owes its success in large measure to the efficiency of the Eye Banking network across the world and to the high standards of technical, ethical, and legal processes that are maintained. According to the Global Survey, India has the largest number of Eye Banks in the world  and, thus, has an opportunity to lead the way in this important sector of eye care. Scarcity of donor corneas, a large burden of corneal blindness, and inaccessibility to surgical centers are some of the challenges that beg to be addressed. Nonetheless, it is commendable that a new corneal storage medium has been developed indigenously, with facilities at par with the best in the world, tested and validated scientifically and offered, in keeping with the philosophy of its parent organization, at a fraction of the cost of comparable media used internationally. We salute the Aurolab and the Aravind Eye Care system for their priceless contributions.
Hypothermic storage at 2 °C–8 °C remains the most popular method of corneal preservation worldwide. The earliest hypothermic storage solution, the McCarey-Kaufman (MK) medium has been succeeded by other solutions, claiming better and longer storage–like K Sol, Dexsol, Likorol, Optisol, etc.
This issue of IJO carries a well-written article of a well conducted study entitled “Comparison of Structural Integrity and Functional Status of corneal endothelium stored in Cornisol and Optisol GS.” The results would be very reassuring to the fraternity of corneal surgeons who have already adopted Cornisol as their preferred corneal storage medium.
Although each layer of the cornea has a different role in the allosensitization of the graft recipient, it is the corneal endothelial layer that has been historically looked upon as the principal determinant of the quality of the corneas, its likely clarity, and survival. Slit lamp and specular microscopic visualization allow morphological scrutiny but are indirect, even if universally accepted indicators of a healthy endothelium. The attempt to establish structural integrity and functional viability, as the authors have done, with immunohistochemistry to identify tight junction protein, Z0-1 and the endothelial ion transport channel Na +/K - ATPase adds weightage to their validation. As pointed out by the authors, measuring the transendothelial electrical resistance would be more confirmatory of the functional viability of the endothelial cells.
Degenerative changes are known to progress even during hypothermic storage, and may differ between individual corneas, reflecting differences in vitality. The authors have studied the corneas at various time intervals to document these changes. Perhaps methods to detect corneas that do not tolerate prolonged hypothermia may reduce the risk of primary graft failure  in the future.
Sterility is another aspect of corneal storage that needs uncompromising attention. The choice of Gentamycin, Streptomycin and Penicillin G was envisaged as an optimal combination to cover most organisms that cause post keratoplasty endophthalmitis. With the rapid increase in antibiotic resistance being reported, it remains to be seen if a modification in the combination and/or the addition of antivirals and antifungals are contemplated. Finally, as we march toward cell-based therapy and tissue engineering, it is exciting to crystal-gaze at where corneal transplantation is headed. Whatever promise the future holds, and however magical the journey, the immortal words of Dr. G Venkataswamy, the founder of Aravind Eye Care System will remain relevant in all spheres of human endeavor: “Intelligence and capability are not enough. There must be the joy of doing something beautiful.”
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