Role of eye bank and eye donation, indication and contraindications and steps of eye donation.. how to approach an eye bank , corneal storage methods before transplant and administration af an eye bank.

1. EYE BANKING
DR. NIDHI THAKER

2. • 1906: edumund zirm 1st successful corneal
transplantation
• 1937: V P Filatow : father of modern eye
banking
• 1944: Dr. R. Townley Paton established the
first eye bank in New York City.
• 1953: Stocker revealed the vital role
endothelial cells play in corneal
transparency.
• 1955: Harris and Nordquist, published a
paper that showed endothelium
maintains function at 4°C.

3. • 1961: Eye Bank Association of America
was established
• 1974: McKarey and Kaufman developed
M-K medium which allowed the
excised corneo-scleral rim to be
preserved for up to 4 days at 4°C.
• 1985: Kaufman et al presented K-Sol as
a storage method viable for up to 10
days.

4. What is an Eye Bank ?

5. IT IS A NON PROFIT
COMMUNITY ORGANIZATION
WHICH DEALS WITH THE
COLLECTION , STORAGE , &
DISTRIBUTION OF CORNEA FOR
THE PURPOSE OF CORNEAL
GRAFTING , RESEARCH & SUPPLY
OF THE OTHER EYE TISSUES FOR
THE OTHER PURPOSES

6. Functions of an Eye Bank :
 Promotion
 Registration
 Tissue Retrieval
 Tissue Processing
 Tissue Evaluation

7.  Serological Testing
 Tissue Distribution
 RESEARCH ACTIVITIES:
• IMPROVEMENT IN PRESERVATION
METHODOLOGY
• CORNEAL SUBSTITUTE
• UTILIZATION OF THE OTHER COMPONENTS
OF THE EYE

8. Other uses:
• Donated Sclera can be used for glaucoma ,
oculoplastic and retinal surgeries
• Human amniotic membrane can be used
for ocular surface procedures
• Fair and equitable distribution of
transplantable tissues to corneal surgeons
acco to waiting list.

9. STEPS OF EYE DONATION
1. Donor selection
2. Tissue retrival
3. Corneal examination
4. Tissue transportation
5. Storage of corneal tissue
6. Distribution

10. DONOR SELECTION
1) AGE OF DONOR:
no influence of age on tranplant
outcome.
Older age : usage rate declines
Lower limit : 2 yrs to prevent myopic shift
after keratoplasty

11. 2) Medical history review
Eye banks must have consistent policies for
the examination and documentation of
donor's available
• medical records,
• medical history
• cause of death
• Medications
• laboratory reports

12. 3) Legal consent taken from next of kin
consented donor meets medical and social
history screening criteria
physical assessment reveals no
contraindication to donation
acquisition of donor tissue can be carried
out.

13. CONTRAINDICATION FOR THE USE OF
DONOR TISSUE FOR KERATOPLASTY
1. Death of unknown cause
2. Death from central nervous system
disease of unestablished diagnosis
3. Creutzfelt-Jacob disease or a risk factor
4. Subacute sclerosing panencephalitis
5. Progressive multifocal
leukoencephalopathy
6. Congenital rubella

14. 7. Reyes syndrome
8. Active viral encephalitis
9. Active septicemia
10. Active bacterial or fungal endocarditis
11. Active viral hepatitis
12. Rabies
13. Active leukemias
14. Active disseminated lymphomas
15. High risk for HIV infection
16. Hepatitis B surface antigen positive

15. 17. HTLV-I or HTLV-II infection
18. Hepatitis C seropositive donors
19. HIV seropositive donors
22. Retinoblastoma, malignant tumors of the
anterior ocular segment
23. Active ocular inflammation
24. Congenital or acquired disorders of the
eye
25. Prior intraocular surgery or anterior
segment surgery

16. 4) Serology testing
5)Preperation of the donor
povidone iodine 1- 5 % for 1-2 min
+
good stream of balanced saline

17. TISSUE RETRIVAL
enucleation
i.e. surgical by in -situ
removal of the whole eye corneo-scleral
excision
(glob is retained
In the orbit)

20. CORNEAL EVALUATION

21. Corneal evaluation
• Examination of the corneas in situ
• A simple penlight examination:
1. epithelial defects (drying, erosion, sloughing
2. corneal edema with associated haze
3. abnormal corneal shape
4. blood or cloudiness in the anterior chamber
5. corneal scars or infiltrates, arcus senilis, and
any signs of conjunctivitis and discharge.

24. • The slit-lamp examination:
• Low power & higher power
• Whole eyes can be examined within the
container used for the retrival
• Excised cornea : from the bottom of the
storage vial
• Cornea shd be allowd to reach the room
temp.

26. • A specular reflection of the endothelial
layer can be observed in a small area of the
endothelial reflex.
• The condition of the corneal endothelium
is central to evaluating the suitability of
corneal tissue for penetrating keratoplasty.

27. Methods of endothelial
evaluation
• Specular microscopy : Mostly used by eye
banks using hypothermic storage of
corneo-scleral buttons.
• other methodS:
1. phase contrast microscopy
2. Transmitted light microscopy
• critical density: 300-500 cells/mm3
• Functional cell density: 1500-2200
cells/mm3

28. STORAGE METHODS

30. 1)Moist chamber storage
• 1st described by Filatov
• Sealed chamber with saline &
antimicrobial solution
• Placed at 4▫ C
• Disadv: corneal stromal edema
& limited storage period ( up to 24
hrs)

31. Hypothermic corneal storage
• Mc carey and kaufman ; M K MEDIUM
• Added dextran as an osmotic soln
• Viability: 2-3 days
• M – K FORMULATION :
add HEPES as buffer & gentamicin &
phenol red
Viability perid : 4 days

32. • K SOLUTION :
M – K FORMULATION +
2.5% chondroitin suphate
 to extend the corneoscleral storage period
to up to 7 – 10 days
Disadv: corneal swelling

33. • DEXOL :
+ DEXTRAN TO K SOL
• OPTISOL :
storage period max up to 14 days
OPTISOL GS:
+ GENTAMICIN & STREPTOMYCIN

34. Normothermic storage system
• Organ culture
• Incubated at room temp in nutrient medium
• Storage perid : 30 days
• Glass bottle containing
1. 100 ml of MEM medium
2. Earle’s salt soln
3. 2.5% fetal bovine serum

35. 5. L – glutamine
6. Antimicrobial agents
cultured bottle is closed & icubated in dry
and at 31 - 37▫ C

36. Uses of Donated Eyes
Corneal Transplantation
Emergency Patching
Medical Education
Research

37. EYE BANK ORGANIZATION

38. THREE TIER ORGANIZATION
An integrated
system involving a
three-tier community
eye banking pyramid
based on the
infrastructure and
manpower at all levels
.
• The three tiers
proposed were eye
donation centres, eye
bank and eye bank
training centres.

39. EBTC• . The top tier comprises of 5 Eye banking
training centers (EBTC)
• responsible for
1. tissue harvestin processing &
distribution,
2. creating public awareness
3. training and skill up-gradation of eye
banking personnel.

40. Eye banks
• middle tier would comprise of a strong
network of 45 Eye Banks(EB)
• These would cater to a population of 20
million each. These Eye Banks would be
closely linked with 2,000 Eye Donation
Centers- EDC (ratio of 1: 50 suggested),
each of which would cater to a population
ranging from 50,000 to 100,000.

41. EYE BANK PERSONNEL
1) EYE BANK INCHARGE:
2) EYE BANK TECHNICIAN
3) CLERK – CUM– STOREKEEPER
4) MEDICAL SOCIAL WORKER /
PUBLIC RELATION OFFICER
5) DRIVER -CUM - PROJECTIONIST

42. • 1. General supplies
a. Donor information sheet, consent forms, etc
b. Pen-light—for gross examination of eyes
c. Insulated container with water ice and special foam to
transport the tissue
d. Supplies for blood collection
e. Non sterile preparatory gloves
f. Broad spectrum antibiotic solution
g. Eye protection (safety goggles), shoe covers
h. Disinfectant solution
i. Eye caps/prosthesis
j. Biohazard disposable bag
k. Gauze and cotton pads
Two small closed stainless containers for gauze pads
soaked in 70 percent alcohol in one and 5 percent
betadine in the other.

43. • 2. Autoclaved and sterile materials:
a. A double holed drape
b. Protective biohazard apparel-surgical gown
(preferably moisture impermeable) cap, mask, etc.
c. Cotton tipped applicators or hemostats to open the
eyes.
d. Sterile balanced salt solution or 0.9 percent sterile
saline to irrigate the eyes
e. Two sterile hemostats .
f. Sterile gloves
. g. 8–10 pieces of gauze.
h. Two eye jars with eye cages and a piece of 2" × 2"
gauze. Eye jars should be labeled left and right.

44. • 3. All instuments of enucleation procedure
& For corneal excision (autoclaved)
• Blood samples are taken from the donor
that is serologically tested for human
immunodeficiency virus 1 and 2, Hepatitis
B surface antigen and Hepatitis C virus.

45. EYE DONATION CENTERS
• Publicity of the volantary donation
• Registration
• Arrangement for the collection of the
eye after death
• Processing , packing , & transportation of
collected eye to attached eye bank

46. The Present Scenario in
Our Country
• Though the first eye bank in
India was started as early as 1949
at Chennai, till the 90’s, our
country had to depend on Sri
Lanka for donor eyes.

47. Don't Burn or Bury
Your Eyes.....
Donate Them!

48. Blind Population
1. World - 40 millions
2. India - 15 millions
3. Corneally Blind - 4.6 millions

49. • According to Indian Council
of Medical Research (ICMR)
25% of the total blind in India
are blind due to corneal
blindness

50. Causes of Corneal Blindness
1. Infections
2. Injuries
3. Corneal Deteriorations
following Eye Surgery

51. LEGAL ASPECTS IN INDIA
• Under the Transplanta- tion of Human Organs Act,
1994 (THOA)
1. The qualification of doctors permitted to perform
enucleation (surgi- cal eye removal) has been re-
duced from MS (Ophth.) to MBBS.
2. Eye donation in India is always decided by the
donor’s surviving relatives and not by the actual
donor,
3. Enucleating doctors always have to legally obtain
a written consent from the relatives of the
deceased be- fore they actually remove the eyes.

52. Eye Donation
is Simple!

53. Removal of Eyes
takes 20 minutes only
Does not delay
funeral arrangements

54. Eye Balls
should be removed
within 6 hours after death