Rezumat. Patologia corneei reprezintă a treia cauză de orbire la nivel mondial, după cataractă și glaucom, cu afectarea a circa 10 milioane
de persoane care suferă de cecitate bilaterală. Se estimează că 12 milioane de oameni sunt în așteptarea transplantului
de cornee. Doar 50 de țări acoperă necesitatea proprie de servicii de transplantologie. Majoritatea pacienților din listele de
așteptare sunt din țări unde lipsește banca de transplant sau nu au acces la țesuturi donate.
Introduction. Corneal pathology is considered
the third leading cause of blindness worldwide,
after cataracts and glaucoma, with 10 million
people with bilateral corneal blindness [1]. An estimated
12 million people are waiting for a corneal
transplant. 50 countries are considered self-sufficient,
almost self-sufficient or adequate for corneal
transplantation [1]. Most patients on waiting lists
live in countries without an eye bank or do not have
routine access to donated tissues.
Global data from a 2012 study, in which the
Republic of Moldova also participated, show that
184.576 corneal transplants were performed in 116
countries out of the 148 countries participating in
the study [2]. According to this study, the United
States had the highest transplant rate - 19.91 per
100,000 population, followed by Lebanon - 12.21
per 100,000 population and Canada - 11.7 per
100,000 population, while the median of the 116
countries analyzed was 1.91 per 100,000 population.
The global study quantified the considerable
deficiency of corneal graft, with only 1 cornea being
available for 70 needed. As with organs, the
global demand for corneal graft to be transplanted
goes beyond the available supply.
Materials and methods. The research was
conducted based on the information about the
transplantation field of the health system, with
reference to national and international data and
sources. Underlying the research was the analysis
of key elements in the activity of donation and transplantation of human tissues during the years
2013 - 2019.
Results. In the Republic of Moldova, in the
structure of ophthalmic morbidity, corneal pathology
occupies a third place and constitutes 23% of
the total number of ocular pathologies. Inflammatory
processes that produce corneal ulcers, considered
an ophthalmic emergency, account for 20% of
cases [3].
The waiting list for corneal transplants is growing
steadily, an average of 27.25 ± 9.9 patients per
year, or 7.8 patients per million population. The rate
of patients who received corneal transplants compared
to patients enrolled in the waiting list varied
depending on the actual number of donors, and
was the highest in 2013 and accounted for 77%,
then decreased to 11.8% in 2015, and subsequently
increased to 33.8% in 2019.
During the research period, the total annual
number of corneal transplants in average was of 9.5
with 9.5 grafts per million population. The rate of
transplanted patients compared to patients on the
waiting list averaged 36.1 ± 11.7% (10.3 patients
per million population), that is, only 1 cornea available
for almost 3 patients in need of a transplant.
The Human Tissue Bank collected and processed an
average of 46.8 ± 4.6 corneas per year from 23.2 ±
2.4 deceased donors, of which an average of 11.2
± 3.3 (23.9%) they were destroyed for various reasons.
Thus, in order to achieve 100% coverage of
corneal transplant services in relation to needs, it would be necessary to perform ≈26.3 corneal grafting
surgeries per million population annually.
The study carried out a comparative analysis of
average data on tissue transplants in the EU countries
for 2018, with data from the Republic of Moldova.
At the level of the EU countries, in 2018, 26.5
ophthalmic tissue transplants were performed with
48.4 grafts per million population (data provided by
21 countries with 416 million population) [4]. Therefore,
the estimated annual needs for the Republic of
Moldova correspond to the number of corneal grafting
surgeries performed in the EU countries.
Conclusions. The study revealed that annual
assessment of the degree of assurance of the health
system with corneal grafts and ensuring minimum
stocks in the Human Tissue Bank will cover the needs
of practical medicine. This requires a complex analysis
of the donation and transplantation process at
the national level, the activity of the Human Tissue
Bank, the morbidity of the population through various
diseases that require transplantation.
