The active storage machine (ASM) allows detecting traces of corneal refractive surgery: case report

Purpose The detection and selection of corneas operated on for refractive surgery (LASIK or photorefractive keratectomy (PKR) by excimer) will become a major concern for eye banks in the coming years because this surgery is often forgotten during the interview with the deceased's relatives. Passive storage in organoculture (OC) prevents the detection of the traces of this surgery because of stromal edema making the cornea less transparent and wrinkled. On the other hand, the active storage machine (ASM) restores intraocular pressure, restores the cornea to its original shape, respects transparency and incorporates non‐invasive controls. It is, therefore, likely to facilitate the detection of refractive surgeries. We present here the case of 2 corneas operated on with PKR and stored successively in OC and ASM. Methods The 2 corneas of a 49‐year‐old donor operated 20 years earlier by PKR for ‐2 and ‐3 diopters myopia were stored in OC for 14 days and then placed in ASM for 48 hr. Transparency (transparometer, BiiGC), thickness map and OCT topography (Casia 1, Tomey) were performed under the 2 storage conditions. At the end of the observation, histology and electron microscopy were performed. Results Traces of PKR remained unnoticed in OC while they were evident in ASM: central epithelial anomaly, central thinning and flattening of central keratometry were found respectively in transparometry, pachymetry map and OCT topography. Histology and ultrastructure confirmed the absence of Bowman's membrane, pathognomonic of PRK. Conclusions By placing the cornea under physiological conditions, and in particular by triggering its deswelling thanks to the intraocular pressure and by restoring its natural curvature, the ASM should allow effective detection of refractive surgery traces.