Corneal opacity
Corneal disease is second only to cataract as a cause of blindness. Worldwide it is estimated that some six million people are blind from corneal scarring, and many millions more have varying degrees of visual impairment from corneal pathology. Blindness from corneal scarring can be the consequence of a variety of infections of the eye such as trachoma and herpes simplex, and may also occur as a complication of measles infection, or from vitamin A deficiency. All these conditions are particularly prevalent in developing countries, and the burden of blindness falls particularly hard in places where there is little on offer in the way of treatment or support.

Keratec: the work so far….
Keratec Eye Bank was founded to support research and development into methods of treatment of corneal disease. Until recently, virtually all corneal graft operations have involved transplanting the full thickness of the cornea in an operation called penetrating keratoplasty. Over the past ten years, Keratec has been pioneering a new method of partial thickness corneal transplantation called deep lamellar keratoplasty (1). This has the major benefit of being free from the problems of graft rejection that are sometimes seen with the conventional penetrating corneal graft. In addition, with the new lamellar technique it is possible to use freeze-dried corneal tissue, and this has several advantages, including prolonged storage of the tissue, and an increase in the proportion of donated corneas that can be used for transplantation.

Vision 2020
The World Health Organization (WHO) has initiated a project (2) - Vision 2020, to eliminate avoidable blindness in the world by the year 2020. The Keratec 2020 Project goals are to make our contribution to the elimination of blindness from corneal disease, through research, teaching, and service commitments. Corneal graft surgery is now moving towards a range of selective transplantation procedures, where individual layers of the cornea are replaced as required, rather than removal and replacement of the whole cornea. This means that eye surgeons are now much more reliant on eye banks to prepare and process eye tissue to meet the exact needs of the patient. Our laboratory research currently focuses on the methods of preparation of individual cell layers of the cornea, and it is likely that in the long run that an increasing proportion of graft tissue will be biosynthesised in the laboratory for use in transplantation.

More clinical research is also needed to refine the methods and indications of these new treatments. Our pilot studies have been encouraging, but further work needs to be done. Considerable difficulties arise in arranging to collect follow-up data in many locations where the need for corneal treatment is greatest (3). Keratec's role as an educational vehicle to promote the new technical advances will continue to be important to further these developments. The Keratec 2020 Project strategy is reliant on the core service of provision of corneal tissue from the eye bank.

Appeal
Ophthalmic surgery has seen some amazing technical developments over the past few decades with the introduction of intra-ocular lens implants, phaco-emulsification for the treatment of cataracts, and excimer laser correction of optical defects. These innovations owe their development in large part to the commercial forces behind the technological advances, which are driven by the large market place for the associated technical equipment and devices. Unfortunately since corneal disease is not a big problem in the affluent parts of the world, it has not been a research priority. Corneal transplantation by its nature needs to be conducted on a not-for-profit basis, and corneal graft procedures are not generally reliant on any sophisticated technology. For all these reasons funding for development of treatments for corneal disease are urgently needed. The Keratec 2020 Project appeal aims to raise £250,000 to further our aims in meeting the demands of corneal transplantation in the 21st century. Your financial contribution to our work will help us to meet the Vision 2020 goal.

References:
1) Deep lamellar keratoplasty with lyophilized tissue in the management of keratoconus. Coombes AGA, Kirwan JF, Rostron CK.
    Br J Ophthalmol 2001;85:788-791.   Abstract      Full Text as pdf

2) Global initiative for elimination of avoidable blindness. WHO Fact Sheet no:213. http://www.who.int/inf=fs/en/fact213.html

3) Lamellar keratoplasty with lyophilised tissue for treatment of corneal scarring: a pilot study in Pakistan.  Tayyib MT, Sandford-Smith JH, Sheard CE, Rostron CK.  Refract Corneal Surg 1993;9:140-142.   Abstract   Full Text

Keratec Eye Bank, St George's, University of London, Cranmer Terrace, London, SW17 0RE

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