Background: Corneal lenticules can be banked and retrieved for vision-restoring surgeries. Extended transportation logistic delays from the lenticule bank to the clinic could be a concern. This study investigated the effects of transportation on the lenticules. Methods: Lenticules were cryopreserved at a Ministry of Health-licensed lenticule bank for 1 year and were transported at 4oC. The transparency was measured daily until significant degradation was notable, compared to fresh lenticules from donor corneas (n=3). The molecular and ultrastructural integrity of lenticules after 1 day in transport (n=3) and on the day of transparency deterioration (n=3) was evaluated by histochemistry and transmission electron microscopy (TEM). In addition, 6 rabbits were implanted with these lenticules to assess the difference in postoperative outcomes by corneal imaging, immunofluorescence staining, and TEM. Results: Lenticules showed a significant transparency reduction after 6 days in transit (p=0.002). The change was not caused by molecular alterations but by a greater distribution shift in the interfibrillar distance (IFD) (Z=4.419; p<0.001) and fibrillar diameter (FD) (Z=6.435; p<0.001). Post-implantation, day 6 lenticules exhibited greater haze and slower recovery of clarity compared to fresher lenticules, despite corneal imaging and immunofluorescence staining showing no fibrosis, inflammation, or vascularization in either group. With TEM, the discrepancy was revealed due to the difference in the recovery of IFD and FD distribution. Conclusions: Banked lenticules can maintain transparency for up to 5 days of transportation at 4oC. Further delays compromise their ultrastructural integrity and postoperative clarity, emphasizing the need to factor in transportation in lenticule banking logistics.

J.S.M. is a medical advisor for Cordlife Singapore and Carl Zeiss Meditec. The rest of the authors do not have any conflicts of interest to declare.

This study was funded by NMRC Clinician Scientist Award-Senior Investigator (MOH-000197-00) and The Lee Foundation Grant (R1917/45/2022)

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB of SingHealth-Duke-NUS waived ethical approval for this work because the provision and consent taking of the tissues were carried out by the U.S. eyebank and Singapore lenticule bank, who were not involved in the study.

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