Older corneas effective for transplants

ASSOCIATED PRESS

Older corneas seem to transplant as well as younger ones, says a major study that promises to expand the age of cornea donation to 75.

It may sound surprising. After all, younger organs and tissue are more coveted for most types of transplants and corneal surgeons have debated the use of older eye tissue.

But government-funded researchers randomly assigned cornea recipients to get either younger or older tissue and found the corneas of both groups survived just as well five years later. The study was published yesterday in the journal Ophthalmology.

“We now have scientific evidence showing that older donors can be used reliably in corneal transplantation,” said Dr. Edward Holland of the University of Cincinnati and one of the study’s lead researchers.

The cornea is the clear covering for the front of the eye, crucial for helping it focus light. More than 39,000 corneal transplants were performed last year, according to the Eye Bank Association of America.

The nation has had an adequate supply, but specialists say there are international shortages. Eye banks fear U.S. supplies will tighten as a result of tougher Food and Drug Administration donor-safety rules that began last summer, increasing interest in older donors.

Transplant surgeons decide how old a cornea they will accept. Some surgeons, Dr. Holland included, have worked with eye banks that accept corneas from donors older than 65. Other banks set younger limits, although age isn’t the most important factor. Donors must be in good health and free of various infections, and the corneas must contain enough of a particular cell type, endothelial cells that balance fluid to keep the cornea clear, not cloudy.

To determine whether age mattered, the National Eye Institute funded the study at 80 medical centers. Researchers recruited about 1,000 people who needed new corneas because of two conditions — a swelling known as Fuch’s dystrophy and a complication of cataract surgery — that together account for almost half of corneal transplants. Most were in their 60s and 70s, although 12 percent were in their 50s and 3 percent in their 40s.

Participants were divided into two groups, getting corneas either from donors ages 12 to 65 or from those 66 to 75. Then researchers tracked how often the transplant failed, because the cornea was rejected or turned cloudy. Five years later, 86 percent of both groups still had successful transplants.

“There was a bias against older tissue,” said co-author Jonathan Lass of University Hospitals Case Medical Center in Cleveland. “This is going to change our view of that.”