Screening corneas for human immunodeficiency virus type 1 proviral DNA by polymerase chain reaction

Association of Federal Regulations in the United States and Canada With Potential Corneal Donation by Men Who Have Sex With Men

Question

Regarding federal policy in the United States that prohibits corneal donation by men who have had sex with another man (MSM) in the preceding 5 years (or 12 months in Canada), what is the association of these policies with the supply of donated corneas?

Findings

These policies were associated with the disqualification of an estimated 1558 to 3217 corneal donations by otherwise eligible MSM donors in the United States and Canada in 2018.

Meaning

With reliable modern HIV testing and with many countries experiencing severe corneal shortages, these federal policies may be decreasing the availability of vision-restoring surgery, suggesting these policies should be reevaluated in light of current scientific evidence.

Importance

Federal policy in the United States prohibits corneal donation by men who have had sex with another man (MSM) in the preceding 5 years, whereas Canada enforces a 12-month ban. The potential consequences of these policies on corneal donations should be evaluated.

Objective

To estimate the number of potential corneal donations associated with MSM deferral policies in the United States and Canada.

Design, Setting, and Participants

A nonvalidated telephone survey study was conducted of all 65 eye banks in the United States and Canada to investigate how many potential corneal donors were disqualified in 2018 because of federal MSM restrictions. Published demographic data were also used to arrive at a separate estimate. Survey data were gathered from May 2019 to February 2020.

Main Outcomes and Measures

Eye banks were asked if they keep records of referrals disqualified specifically because of the federal MSM restrictions and, if so, how many referrals they disqualified in 2018 owing to MSM status.

Results

Fifty-four of 65 eye banks (83%) responded to the survey, with 30 eye banks reporting they do not keep specific records of MSM deferrals. The remaining 24 eye banks reported disqualifying 360 referrals in 2018 because of MSM status, equating to 720 corneas. The 24 eye banks accounted for 46.2% of corneal donations in the United States and Canada in 2018, yielding an estimate of approximately 1558 corneas rejected that year because of MSM status. A separate estimate using published MSM demographic data indicates that up to 3217 potential corneal donations may have been disqualified in 2018 because of these federal policies.

Conclusions and Relevance

Findings suggest that between 1558 and 3217 corneal donations were disqualified in 2018 because of federal regulations prohibiting corneal donation by men who have had sex with another man in the preceding 5 years in the United States or 1 year in Canada. With modern virologic testing that is reliable within days of HIV exposure and given the global shortage of corneal tissue, these policies should be reevaluated using current scientific evidence to increase the availability of vision-restoring surgery worldwide.

Human immunodeficiency virus and its effects on the visual system

During the first 15 years of the AIDS epidemic patients experienced a high incidence of blindness due to cytomegalovirus (CMV) retinitis and other severe ocular opportunistic infections. Highly active anti-retroviral therapy, introduced in 1996, dramatically decreased the incidence of CMV retinitis. Though CMV retinitis still causes 40% of vision loss in AIDS patients, other conditions such as immune reconstitution uveitis, cataracts, and a significant othercategory -which most investigators believe is directly due to HIV - comprise the majority of cases. HIV causes vascular abnormalities of the conjunctiva and retina in the majority of AIDS patients, as well as retinitis, anterior and posterior uveitis and vasculitis. HIV frequently causes an optic neuropathy and is responsible for the majority of eye movement disorders among HIV patients. Physicians need to be aware that these problems may be the initial manifestation of HIV infections or a sign of highly active anti-retroviral therapy (HAART) failure. Therefore, patients with identifiable risk factors for AIDS who present with ophthalmologic conditions of unknown etiology should be considered for HIV testing. Finally, anti-retroviral therapy has been reported to cause asymptomatic deposits as well as degenerative conditions of both the anterior and posterior segments of the eye.

Assessing Responses of the Macula in Patients with Macular Holes using a New System Measuring Localized Visual Acuity and the mfERG

PURPOSE

To evaluate acuity and multifocal electroretinogram (mfERG) responses from the macula in affected and unaffected fellow eyes of patients with macular holes.

METHODS

We tested 10 eyes with macular hole and 10 fellow eyes from 11 patients. We measured local visual acuity thresholds at 27 discrete locations within 21 degrees diameter using the Functional Fundus Imaging System (FFIS), a psychophysical system that measures visual acuity as a function of visual field location, and local ERG responses within 45 degrees diameter using the mfERG.

RESULTS

In the affected eyes, the mean FFIS visual acuity thresholds were significantly elevated within the central 21 degrees diameter area, compared to a group of control eyes. No significant differences were found between the acuities of the fellow eyes compared to those of the control group. The amplitudes of the first positive peak of the mfERG were reduced in the central 7.8 degrees in affected eyes. In the central 2 degrees , 4 out of 10 affected eyes showed non-measurable ERG signals. The remaining six eyes showed significantly reduced mean amplitudes, but not delayed implicit times, when compared to the control group. For the fellow eyes, the mean amplitudes of the mfERG and implicit times did not differ from the means of the control eyes.

CONCLUSIONS

Both local psychophysical and electrophysiological testing demonstrated retinal dysfunction extending beyond the site of the macular holes in some patients (three of the patients had central mfERG amplitudes falling within the normal range).

Feline leukemia virus detection in corneal tissues of cats by polymerase chain reaction and immunohistochemistry

OBJECTIVES

To determine the presence of feline leukemia virus (FeLV) in the corneas of FeLV-infected cats.

ANIMALS STUDIED

Thirty-four random source cats.

PROCEDURES

Seventeen cats were found positive for FeLV serum p27 antigen by enzyme-linked immunosorbent assay (ELISA). Twelve ELISA positive cats were also positive on peripheral blood samples by immunofluorescent antibody (IFA) testing. Seventeen ELISA negative cats served as negative controls. Full thickness corneal specimens were collected from the left cornea of all cats and analyzed for FeLV proviral DNA and gp70 antigen by polymerase chain reaction (PCR) and immunohistochemical (IHC) testing, respectively.

RESULTS

Eleven (64.7%) positive corneal PCR results were obtained from 17 ELISA positive cats. Of 12 cats that were both ELISA and IFA positive on peripheral blood, 10 (83.3%) had positive corneal PCR results. All corneal tissues from ELISA negative cats were PCR negative. IHC staining of corneal sections revealed the presence of FeLV gp70 in corneal tissues of nine (52.9%) ELISA positive cats. Of the 12 cats that were both ELISA and IFA positive on peripheral blood, eight (66.7%) had positive corneal IHC results. Positive IHC staining was localized to the corneal epithelium. Corneal tissues of all ELISA negative cats and all IFA negative cats were negative on IHC testing.

CONCLUSIONS

FeLV antigens and proviral DNA are present in corneal tissues of some FeLV-infected cats. Screening corneal donors for FeLV infection is warranted.

Lack of virus transmission by the excimer laser plume

PURPOSE

To test the possibility of pathogenic virus transmission into the operating suite during excimer laser treatment of corneal tissue. Such treatment vaporizes corneal tissue, which may put the surgeon at risk of infection from human immunodeficiency virus, hepatitis virus, or other viruses. We developed a model system to test the possibility of such virus transmission.

METHODS

Pseudorabies virus is a porcine enveloped herpesvirus similar in structure and life cycle to human immunodeficiency virus and herpes simplex virus. An excimer laser was used to ablate a virus-infected tissue culture plate while an uninfected tissue culture plate was in an inverted position over the infected plate. Six hundred laser pulses were applied. Pseudorabies virus in the excimer laser plume would, potentially, contact and infect the uninfected cells. The experiment was repeated 20 times with appropriate positive and negative controls.

RESULTS

None of the 20 uninfected plates was infected by the laser plume rising from ablation of infected tissue culture plates. Positive and negative controls performed as expected.

CONCLUSIONS

Even under conditions designed to maximize the likelihood of virus transmission, the excimer laser ablation plume does not appear capable of transmitting this particular live enveloped virus. Excimer laser ablation of the cornea of a human immunodeficiency virus (HIV)-infected or herpesvirus-infected patient is unlikely to pose a health hazard to the surgeon.