(b)“Altered immune responses”: we know that VEGF is a potent chemoattractant for inflammatory cells and an essential component of the “immune amplification cascade” leading to a robust inflammatory response in the cornea. Anti-VEGF strategies may alter that ability to mount an effective immune response.

(c)“Wound healing problems”: Wound healing problems are a well known side effect of angiogenesis inhibitors in vascularized tissues. But even in the avascular cornea, VEGF may play a role in wound healing. Corneal epithelium, e.g., expresses VEGFR3, which besides neutralizing VEGF-C and -D, and thus maintaining corneal angiogenic privilege, may also have an effect on epithelial proliferation. In addition, VEGFs known effect on recruitment of inflammatory cells, especially macrophages may alter corneal stromal wound healing.

Unmet Needs and Future Directions

The are numerous unmet medical needs in the management of corneal neovascularization (CN), in the scientific understanding of disease mechanisms involved in CN, and in proposing consensual approaches for the development of new drugs in this field in terms of inclusion criteria and clinical endpoints to be considered as clinically relevant. A recent consensus statement lists all current unmet needs in that field [33].

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Elisabeth Pels and Graeme Pollock

Core Messages

•The foundations of eye banking and corneal preservation were laid by Filatov in 1937 [1] with the recognition that donor tissue for corneal transplants could be recovered post-mortem.

•Over the past few decades the responsibility for the provision of a viable, disease-free donor cornea has been entrusted to the eye bank, and the ophthalmic surgeon now has to rely on these services as an important aspect of their surgery and treatment.

•With the appreciation that corneal transplantation could potentially transmit a number of diseases from donor to recipient, eye banks became increasingly responsible for donor screening for such diseases and standards to assist in these practices were developed.

•Today, eye banking services are provided in an environment of stringent quality assurance standards, often with increasing government regulation or oversight. Quality management systems and risk assessment have become important aspects of eye banking where the emphasis is now not only on quantity of tissue provided but also where quality of tissue and quality of service have become priorities.

E.Pels, Ph.D. (*)

Cornea Bank Amsterdam, Euro Tissue Bank, Markt 58, 1941 BM Beverwijk, The Netherlands e-mail: epels@eurotissuebank.nl; e.pels@hetnet.nl

G. Pollock, Ph.D.

Lions Eye Donation Service Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, 3002 Melbourne, VIC, Australia

e-mail: graemeap@unimelb.edu.au