Presentation on theme: "EYE BANKING Dr. Smitha.

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1 EYE BANKINGDr. Smitha

2 HistoryIn rabbit corneal transplantation was done by FRANZ REISINGER In

1824 First Corneal Transplantation in human was done by EDWARD ZIRM in 1906
On Mr. Alois Gloger.Filatov(1935) – Father of Keratoplasty1945 First eye bank
established at RIO, Madras1960 First successful corneal transplant Dr. R. P.
Dhanda and Dr. Kalevar

3 Eye Bank Association of America was founded in 1961.

A similar organization was established in India at LVP, Hyderabad 4th January
1989, known as Eye Bank Association of India (EBAI).

4 What Is An Eye Bank?Eye bank is an organization which deals with the

collection, storage and distribution of the cornea for the purpose of corneal
grafting, research and supply of eye tissue for other ophthalmic purposes.It is a
non-profit community based organization, managed by a Board of Directors, eye
bank manager and technician with the objective of increasing the quantity and
quality of eye tissue.

5 The Importance of Eye Donation

Cornea procurement rate-India 22,000/ yearIn India The Number of Corneal Blind
Person are 22 LakhsEvery Year 75,000 to 1,00,000 –Corneal Requirment2,77,000
donor eyes to perform 1lakh/year

6 Eye Donation ONE EYE DONATION CAN GIVE VISION TO TWO PERSON
ONLY TO THE CORNEAL BLIND PERSON

7 The cornea is the clear tissue covering the front of the eye
The cornea is the clear tissue covering the front of the eye. It is the main
focusing element of the eye. Vision will be dramatically reduced if the cornea
becomes cloudy from disease, injury or infection .

8 Corneal blindness is a disorder that results from the cornea becoming clouded,
making a person blind. This condition can result from a variety of diseases,injury
or infection

10 Reasons for Corneal Blindness

1. Infections- Bacterial & Viral2. Accidents3. Hereditary diseases

11 Who can Donate?Any Body can DonateNo Age Bar

12 Male, FemaleSpectacle Wearer also can DonatePatients with Blood
PressureDiabetic PatientsPatients with AsthmaThose who undergone surgery

13 Who can not Donate?AIDSHepatitis BRabbiesSepticimia

14 Eye Bank Research Public Tissue Awareness Harvesting Distribution

EvaluationPreservationPublicAwarenessResearch. .

15 Eye Bank Activities Collection of donor eyes

Process and storage of donor corneaDistributing Corneas to Various Hospitals
Training Technicians about Eye Banking Public Awareness programme

16 Organisation of Eye Bank

Structure : Medical & AdministrativeComponents of Eye Bank1.Eye Information
Centre.2.Eye Collection Centre.3.Eye Bank Proper.

17 Eye information center (EIC)

create awarenessalso issues eye donation card to the pledgerhandover the
signed pledge forms to the eye bankMedical Social Worker

18 Eye collection center (ECC)

Receives call for eye collection,collects the eye,informs the eye bank,dispatch
the eye tissue to the bank andissues an appreciation letter to the deceased
family.

19 Eye bank proper Permission from the Government is necessary Staffing

EquipmentEye Donation fortnight is observed from 25th August to
8thSeptemberHCRP

20 LEGAL ASPECTSRegistered Medical practitioner to certify the death and

procure the eyesProcurement by unregistered & Unauthorized body is
punishableNo sale or paymentPresumed consent LAW

21 Rules of Donation· Donor pledges that his eye can be removed

after death for corneal grafting. Here also permission of next of Kin
needed.· Can be donated by next of Kin if not pledged by donor ·
Law forbids eye removal of living person for donation. Act No.42. Of 1994
Transplantation of human Organs act 1994.

22 Contraindications to procurement
SystemicAIDS and HIV seropositivityRabiesActive hepatitisCreutzfeldt-Jackob
diseaseActive septicemiaSubacute sclerosing pan encephalitisLymphomaDeath
from unknown causeProgressive multifocal
leukoencephalopathyOcularRetinoblastoma,Active inflammatory eye
diseaseKeratoconus, keratoglobusCentral opacitiesPterygiumPrior refractive
procedures- Radial keratotomy, Laser ablation, lamellar inserts.Anterior segment
surgical procedures -

23 Preliminary Steps Eyes to be removed within six hours.

Keep donor’s eyes closed, put a small piece of ice over the lid.Keep head end
raised by six inches.Switch off fan.Keep A.C. onKeep death certificate ready.

24Enucleation Sclero corneal button

PROCUREMENTEnucleationSclero corneal button

25 Enucleation not to be done in presence of family members.

Antibiotic drops to be put into eyes and enucleation done under asceptic
conditions.Conjunctiva to be stitched.Artificial eyes to be put into socket and
lids stitched.Eye to be removed one after another transferred to wide –mouthed
collection bottle. Eyeball to be kept, cornea facing upward, over cotton roll
moistened with antibiotic.The bottle, sealed, put into a thermocol box with ice
cube, transported to eye bank.10 ml of Blood collected

26 What happens after eye donation

.

27 Assessment of Donor Tissue

Slit lamp examination eyeballCorneal button by specular microscope

28 Anterior chamber – any crystals

.Corneal epitheliummicrocystic edema, epithelial defectsCorneal
stormaopacities, infiltrates, edema, DM foldsEndotheliumGuttata, snail track
marks (stress fractures of endothelium)Anterior chamber – any crystals

29 Specular microscopy Edothelial cell density - < 1500cells/mm

Severe polymegathism or pleomarphismPresence of cornea guttataAbnormally
shaped endothelial cells –fused cellsAbnormal single cell defectsSevere edema
of endotheliumPresence of inflammatory cells on endothelium

30 GRADING OF TISSUE EXCELLENT Vacuolated cells No epithelial defect

POORVacuolated cellsSevere stromal cloudinessMarked folds (heavy, numerous,
central)Endothelium- marked defects, low cell density, central vacuolated
cellsEXCELLENTNo epithelial defectNo arcus senilisNo folds in DMExcellent
endothelium – no defects

31 CORNEA GRADING EXCELLENT VERY GOOD GOOD FAIR

NSFS (NOT SUITABLE FOR SURGERY)
32 NSFS (Not Suitable For Surgery)
1. For Training Doctors2. Research and StudyDiabetic
RetinopathyGeneticsGlaucomaCongenital Cataract

33 MANDATORY SEROLOGICALTESTS
HIVHepatitis ‘B’Hepatitis ‘C’SyphilisAll surgical tissue shall be stored in
quarantine until results are negative

34 Methods of corneal preservation

Short term – Moist chamber methodIntermediate term storage –Mc Carey-
Kaufaman medium, chondriotin sulphate enriched mediaLong termOrgan
cultureCRYO - Preservation

35 Moist chamber storage Whole globe in a sealed container 4 degree C

AdvantagesSimple, minimum manipulationDisadvantage – time limit only 48
hours

36 Ingredients of cornea preservation media

Dextran – helps to keep the cornea thinChondroitin sulfate –acts as
antoxidant,helps to retain viability of endotheliumElectorlytes –Buffer buffer
system – Hepes bufferAntibiotics – gentamycinNon essential amino acids –
AntoxidantsInsulin

37 MK Medium Base medium-TC 199 5% Dextran Bicarbonate buffer

Penicilline and gentamycin (50-200mcg/ml)Phenol red as PH indicatorStored at 4
degrees for upto 4 daysCorneal button

38 Chondroitin Sulfate enriched media

K SOLDEXOLOPTISOL(KSOL+DEXOL)TC199Minimal essential
medium(MEM)TC199+ MEM2.5%chondroitin sulphate1.35%chondroitin
sulphateHepes buffer MHepes bufferGentamycin sulfate 100 mcg/mlGentamycin
sufate 100 mcg /mlNon essential a.aNon essental a.a.Sodium pyruvate
1m/moleSodium Pyruvate 1,/moleAdditional oxidants1% DextranSodium
bicarbonateUpto 7days at 4 degUpto 10 days14 days.

39 Long term storage ORGAN CULTURE METHOD Upto 35 days

Earle’s salts without L- glutamineL- glutamineDecomplemented calf serum1.5%
chondroitin sulfate

40 Tissue frozen at controlled rate upto -80 deg C

.CRYOPRESERVATIONCorneal rim is passed through a series of solutions
containing increasing concentration of dimethyl sulfoxide (DMSO) upto
7.5%Tissue frozen at controlled rate upto -80 deg CStored indefinitely at -160
deg CNot popularDisadvantagesExpensiveHighly trained technical persons
neededSlight error can lead to tissue damage
41 CODE OF ETHICS FOR EYE BANKS
.CODE OF ETHICS FOREYE BANKSNo rivalry with other eye banks.Free exchange
of eye with other banks.No eye to be enucleated during life.Eye not to be bought
or sold.No discrimination during the distribution.Donor identity not to be
disclosed.Proper wait list to be maintained.Bank not to have commercial
publicity.Pledging and funding to be done in defined manner.

42 CODE FOR EYE SURGEONS Competence to perform corneal surgery.

Donor cornea not to be bought or sold.Competence to perform corneal
surgery.Cornea to be obtained from recognized bank onlyDonor identity not to be
disclosed.Should process all medical details of donor and cornea.

43 CODE FOR COLLECTING PERSONNEL

.CODE FOR COLLECTING PERSONNELShould be polite, courteous, and
sympathetic with donor relatives.Enucleation to be done in privacy.Eye removal
only by ophthalmologist or medical practitioner trained in enucleation .Should be
respectful to the deceased’s body.Mutilation to the body to be avoided.Relatives
to be intimated about the artificial eyes.Donated eyes to be collected even if
unsuitable.Legal consent form to be signed and obtained.

44 HCRP MoU Activities for awareness Grief councellor Advantages

availability of medical historyavailability of tissue from younger
individualsreduction in time interval between death and corneal excisioncost
effectiveness andlarge number potential donors.

45 You can help byPledging your eyes and encouraging your family members to
donate as well.Being a member of the eye donation centre.Calling the nearest
eye bank immediately when a death occurs in the family.Motivating friends and
relatives of the deceased to donate eyes.Monetary support to the patient or to
the Eye bank.

46 .THANK YOU