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December 15, 1999

Preventing Prion Transmission in Corneal Transplants

Author Affiliations

Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

JAMA. 1999;282(23):2211. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-23-jbk1215

To the Editor: We agree with the Council on Scientific Affairs' recommendation that "physicians become knowledgeable about BSE [bovine spongiform encephalopathy] so they can appropriately advise their patients about routes and rates of BSE transmission."1 Unfortunately, there is only passing mention of prion transmission by corneal transplantation, which is performed on 40,000 to 50,000 patients each year in the United States.2 In addition to the 1974 US case,3 2 additional cases of probable and possible transmission, respectively, have been reported in Germany and Japan,3 but the major new concern relative to prion transmission via corneas occurred recently in Great Britain. In February 1997, the corneal transplant and sclera from a 53-year-old woman who had died of presumed metastatic lung cancer were transplanted to 3 recipients.4 In November 1997, the donor's brain revealed sporadic Creutzfeldt-Jakob disease (CJD), confirmed by the United Kingdom CJD Surveillance Unit.4 Although transplanted tissues were subsequently removed, these 3 cases raise particular concern since infectivity of ocular tissue in scrapie was reported as 5.4 log U/mL median infective dose (cornea) compared with 8.9 log U/mL (brain) and 8.5 log U/mL (retina).3