LAUSR

To the Editor: The recent publication of the Barcelona Principles1 reflects a fantastic effort by the Global Alliance of Eye Bank Associations. At this critical time in ophthalmology, when global boundaries are less restricted, permitting better patient care, it is imperative to set the standards for how precious donated ocular tissue is used. With the advent of lamellar corneal transplantation techniques, the potential to conquer global blindness is even greater than before. We would like to draw the readership’s attention to Principle 3, Strategy II: “Encourage the development and use of new technologies and methods in conjunction/collaboration with the ophthalmic community, that seek to reduce the burden on donor need, and enhance treatment options for recipients.”1 It is clear that the current global supply of donor corneal tissue is not adequate to meet the needs of those who have corneal blindness.2 One avenue to immediately address this issue is considering the allocation of a single donor to multiple recipients. There has certainly been a precedent for this principle.3 Cursiefen et al described successful split cornea transplantation in 100 patients.4 Reports out of India cite 1 donor cornea for 25 or even 36 recipients. We would advocate that the principle of tissue division could be further optimized to potentially benefit 6 recipients: DM and endothelium split into 4 segments for quarter-DMEK,7 Bowman layer harvested for transplantation and a residual stroma that can be used in corneal patch grafting or glaucoma tube shunt surgery. This type of disruptive thinking is a creative means to help increase the current tissue supply and increase the generous gift that current donors give.