4. Eye bank is a non-profit community based
organisation which deals with the collection , storage
and distribution of cornea for the purpose of corneal
grafting ,research and supply of the eye tissues for
several purposes.
It is managed by a board of directors with the
objective of increasing the quality and quantity of eye
tissue.
5. FUNCTIONS OF EYE BANK
EYE BANK
TISSUE
HARVESTING
TISSUE
PRESERVATION
TISSUE
DISTRIBUTION
RESEARCH
PUBLIC
AWARENESS
TISSUE
EVALUATION
6. Magnitude of the problem
Approximately 11 Lakh blind population of our country are waiting
for corneal transplantation and approximately 25,000 new cases are
being reported.
Mostly children and young adults.
As against an annual requirement of 75,000 to 1,00,000 corneas, only
22,000 corneas are donated in India at present.
Vast gap between demand and supply
7.
8. INDICATIONS
OPTICAL – Pseudophakic Bullous Keratopathy(mc in India,
Fuch's keratopathy(mc in western world),keratoconus , corneal dystrophies
and degenerations
TECTONIC – Descemetocele , perforated cornea
THERAPEUTIC – Resistant to medications conditions
COSMETIC – Rare
9. Eye banking in
India
1945 –First eye bank established at
RIO,Madras.
1960-First successful corneal transplant
performed by Dr.R.P .Dhanda and
Dr.Kalevar.
1999-Eye Bank association of India (EBAI)
established.
Medical standards of Eye banking in India.
10. Eyes should be donated within 6-8 hrs of death
Anyone can be donor, irrespective of age, sex, blood group or religion.
Eyes can be donated even if the deceased had not formally pledged their eyes during
their lifetime, if there is consent of the next of kin.
Eye Bank team will rush over to the donor’s home or any other place where the body is
available after death. This is free service in public interest.
Eye banks come under Human Organ Transplantation Act. Donated ayes cannot be brought
or sold as it is a crime under the act.
FACTS
11. THREE TIER ORGANIZATION
It is an integrated system involving
three tier of organisational work
based on the infrastructure and
manpower at all the levels.
1. EYE DONATION CENTRES (EDC)
2. EYE BANKS (E B)
3. EYE BANK TRAINING CENTRES (EBTC)
5 EBTC
45 EB
2000 EDC
12. EYE BANK
TRAINING
CENTRE (EBTC)
Tertiary centre of eye banking system
It involves:
1. Tissue harvesting, processing and
distribution
2. Training and skill upgradation of eye
bank personnel
3. Creating Public Awareness
4. conducting research
13. EYE BANK (EB)
A strong network of 45 EB ;constitute the middle tier of
the eye banking integrated system.
These are closely linked with the EDC (suggested ratio -
1:50)
Provide a round the clock public response system over
telephone and conduct awareness program for eye
donation.
Co-ordinate with donor families and hospitals to
motivate eye donation .
Caters to a population of 20 MILLION each.
14. EYE DONATION
CENTRES (EDC)
Affiliated to registered eye bank
Give public and professional awareness
about eye donation'
Co-ordinate with donor families and
hospitals to motivate eye donation.
To harvest corneal tissue and blood for
serology
To ensure safe transportation of tissue to
the parent eye bank.
CATERS TO A POPULATION OF 50,000
TO 1,00,000
15. Cornea as transplant
Immune privileges of cornea
Absence of blood and lymphatic channel in the graft and its bed .
Absence of MHC class II APCs in the graft.
Reduced expression of MHC coded alloantigen on graft cells
Immunosuppressive environment of aqueous.
16. CONTRAINDICATIONS
Do not use for keratoplasty:
Septicemia
Extensive burns
Death from an unknown cause
Death with CNS disease of unestablished diagnosis
Subacute sclerosing panencephalitis
Progressive multifocal leucoencephalopathy.
17. Intrinsic eye diseases:
Retinoblastoma
Malignant tumors of anterior ocular segment.
Active inflammation at the time of death.
Congenital or acquired diseases of the eye that would preclude
a successful outcome.
18. Endothelial density below 2000 cells per square millimeter
Laser photoablation surgery
Corneas from patients with anterior segment surgery can be used if
screened by specular microscopy and meet the Eye banks endothelial
standards.
Laser surgical procedures such as argon laser trabeculoplasty, retinal and
panretinal photocoagulation donot necessarily preclude use
for penetrating keratoplasty but should be cleared by the medical
director.
19. Viral infections are the greatest hazard.
Viruses with proven transmission –Rabies,CJ disease,Hepatitis B
Possible transmission-HIV,HSV,CMV,adenovirus,Ebstein-barr,rubella
Transmission unlikely-Varizella zoster virus.
All prion diseases are contraindications
Snake bite specific for neurotoxins.
20. Interval between death ,enucleation and
preservation.
If ambient temperature is hot (e.g. summer weather), then eyes must be
preserved or refrigerated within six (6) hours of death
If ambient temperature is not hot (e.g. winter weather), then eyes must be
preserved or cooled within eight (8) hours of death
If ocular area including eyes, or the entire body, or enucleated eyes are
continuously cooled within the above constraints of 6 or 8 hours, respectively,
then tissue can be preserved no later than 24 hours from time of death
21. STEPS OF EYE
DONATION
DONOR SELECTION
TISSUE RETRIEVAL
CORNEAL EXAMINATION
TISSUE TRANSPORTATION
STORAGE OF THE TISSUE
DISTRIBUTION
24. INFORMATION TO BE OBTAINED AT
TELEPHONE REFERRAL
Date and time of referral
Origin of referral (funeral home,hospital)
Full name of person providing information
Name and age of donor
Name of hospital/facility where the donor expired
Time and cause of death
Phone number and location
25.
26. EQUIPMENT & SUPPLIES FOR TISSUE
RETRIVAL
GENERAL SUPPLIES
Donor info sheet
Consent form
Pen torch
Moist chamber
Supplies for blood collection
Non sterile preparatory gloves
Safety googles,shoe covers
Broad spectrum antibiotic solution
Disinfectant solution
2 small closed containers – gauze pads
soaked in 70%alcohol,5% betadine
Gauze and cotton pads
Biohazard disposable bag
Ocular prosthesis
27. AUTOCLAVED AND STERILE MATERIALS
Sterile maintenance cover /barrier drape
Moisture impermeable surgical gown, mask,cap
Cotton tipped applicator/hemostat
0.9% sterile saline
Sterile gloves
Two eye jars (labelled R. & L.)with eye stands & a piece
of 2*2gauze
Cotton balls ,gauze
30. 2.MEDICAL HISTORY
Medical/travel/socail/infection/previous ocular history
Cause of death
Medical records
Medications
Laboratory reports
Visual head to toe inspection
Eye banks must have consistent policies on the examination and selection
criteria and documentation for the donors
35. COMPARISON
BETWEEN GLOBE
ENUCLEATION AND IN
SITU CORNEOSCLERAL
DISC EXCISION ON
CORNEAL
CULTIVATION AND
CLINICAL OUTCOME
OF GRAFTS AFTER
TRANSPLANT-
Study was conducted by Filip Filev et al.
Cornea . 2018 Aug
It was a retrospective study performed on
Hamburg eye bank database using compaative
statistics in 2929 cases.
RESULT- 1) Once the retrieval method was
changed from enucleation to in
situ CD, donation number increased
significantly.
2) Slightly lower endothlial cell density after
retrival in coreas obtained by in situ CD excision
compared with tose from enucleated eyes, whereas
endothelial loss during cultivation was similar.
CONCLUSION- In situ CD excision has similar
cultivation performance and clinical result
compared to enuleation.
36. EVALUATION OF DONOR TISSUE
GROSS EXAMINATION-
Whole Globe: eyes with excessive stromal
hydration should be discarded unless
specular microscopy can be done for
endothelial cell count
Corneoscleral button: colour of the tissue
storage is noted. Yellowish colour-acidic
media- Contamination.
38. SPECULAR MICROSCOPY
ENDOTHELIAL CELL COUNT
- Minimum count should be
1500 cells / sq. mm
- For penetrating keratoplasty
min. count should be 2000
cells / sq. mm
- DSEK –2200 cells/sq.mm
- DMEK –2400 cells/sq.mm
39. Cornea with specular endothelial patterns
unfit for transplantation
Cell density less than 1500 cells/mm2
Severe polymegathism or pleomorphism of endothelial cells
Central cornea guttata
Abnormally shaped cells
Abnormal single cell defects
Severe edema
Presence of inflammatory cells
40. Donor serologic testing
A blood sample from the donor must be tested - this sample may be either:
1. a post-mortem sample drawn as soon as practicable after the time of death, or
at the time of tissue recovery, or
2. a pre-mortem sample drawn within 7 days prior to death
A hard copy of serological results shall be received and assessed by the Eye Bank
prior to release of tissue designated for surgical use.
If the approved testing methodology is only approved for pre-mortem serology
samples and no post mortem testing kits are approved for use, these pre-mortem
test kits may be utilized for testing cadaveric samples.
41. Minimum Testing: Blood (serum or plasma)
must test non-reactive to the following
required infectious diseases:
1. Human Immunodeficiency Virus Types 1
and 2: anti -HIV-1 , anti-HIV-2
2. Hepatitis C Virus (HCV): anti-HCV
3. Hepatitis B Virus (HBV): HBsAg
4. Syphilis
All tissue intended for transplantation shall
be stored in quarantine until results of all
serology testing are complete.
43. SNAIL TRACKS, STESS STRIAE
Careless folding of the corneal
cap while removing causes
snail track lesions.
Image shows the snail tracks
in varying degree of
magnification
44. STORAGE OF DONOR TISSUE
STORAGE
INTERMEDIATE 7-10
DAYS K-SOL, OPTISOL
LONG TERM 30 DAYS
ORGAN CULTURE MEDIUM ,
VERY LONG TERM 1 YEAR
CRYOPRESERVATION
SHORT TERM 2-3 DAYS
MOIST CHAMBER (24 HRS) , MK
MEDIA
45. MOIST
CHAMBER
• Storage of whole globe
• 4 c
• 24 hrs
• Simple to use
• Drawback- sometimes
stromal edema occurs
46. M.K. MEDIUM
Base medium – Tc 199
5% dextran
Bicarbonate buffer
Phenol red as indicator
Stored at 4 c for 4 days
47. INTERMEDIATE STORAGE
TISSUE MEDIA –
Provides a chemically defined and stable environment
Helps support and enhances metabolic activities
Reduces the stromal swelling
Keeps the tissue under sterile condition till use.
Provides time for EB to screen the donor.
49. DEXTRAN
• Keeps the Cornea
thin
• Conc. 1% of 40,000
mol. wt is used
CHONDROITIN
SULPHATE
• Similar to GAG in
cornea
• Low mol. Wt. keeps
endothelium viable
• Also acts as
antioxidant
ANTIBIOTICS
• Penicillin
• Polymyxin
• Gentamicin
50.
51.
52. CORNISOL
• CORNISOL is an intermediate type of
medium
• 20 ml buffered corneal preservation
medium chondroitin sulfate (Membrane
stabilizer), recombinant human insulin
(Metabolism enhancer), Dextran (Osmotic
agent),
• stabilized L-glutamine,
• ATP precursors,
• vitamins, trace elements,
• gentamicin, streptomycin
• pH indicator.
54. CRYOPRESERVATION
Corneal rim is passed through a
series of solutions containing
increasing concentrations of
dimethyl sulphoxide (DMSO) upto
7.5%
Tissue is frozen at controlled rate
upto -80 c.
Stored indefinitely at -160 c
55. DISTRIBUTION OF CORNEA
Distributed only to those hospitals
and ophthalmologist registered
under HOTA
Maintaining the waiting list
Distribution Record
56. HOSPITAL CORNEA RETRIEVAL PROGRAM
It is a revolutionary program Initiated in 1990 to concentrate on deaths
that occur in hospitals and encourage eye donation in their families and
relatives.
Grief counsellor should motivate the family to donate
ADVANTAGES-
• Availability of all the records at hospital
• Reduction in time interval between death and corneal excision
• Increased availability of stronger and younger corneal tissues resulting in
more optical and successful grafts.
57.
58. LEGAL ASPECT OF EYE DONATION
UNDER THE Transplantation of Human Organs Act , 1994
A special provision was included in the Amendment Bill of the THOT,2008
• The qualification of the doctor permitted to perform enucleation was
reduced from M.S. (ophthalmology) to M.B.B.S
• Eye donation in INDIA is always decided by the donor’s surviving relatives and not
the actual donor.
• Enucleating doctors always have to legally obtain a written consent from the
relatives of the deceased before they remove the eyes.
• Donor and recipient of the corneal tissue should be unknown to each other.
59. EYE BANKING AND COVID-19
Advisory for resuming the Eye Banking Activities
The Eye Banking activities to be resumed through hospital cornea retrieval
program (HCRP) and to be from a hospital which is declared as non-COVID
No eye banking activities to be started in the containment areas of Red zones.
Containment zones shall be demarcated within Red (Hotspots) and Orange Zones by
State/UTs and District Administration based on the guidelines of MoHFW
60. • The Recovery Technician/ doctor to use PPE ( including N95 mask, cap,
face shield/visor, gloves, gown) while recovering the donor tissue.
• Eye Bank Association of India recommends that the collection of a nasal
swab of the deceased donor for RT-PCR COVID19 testing can be done
and sent to the laboratory
immediately.
• All collected tissues should be quarantined for 48 hours prior to the
release of the tissue for usage for transplantation. Avoid immediate
usage.
61. EXCLUSION CRITERIA (EBAI)
Tested positive for or diagnosed with COVID -19.
Acute respiratory illness or fever 100.4°F (38°C) or at least one severe or common
symptom known to be associated with COVID -19
Individuals who have been exposed to a confirmed or suspected COVID-19 patient
within the last 14 days, who have returned from nations with more than 10 infected
patients and those whose cause of death was unexplained respiratory failure should
not be accepted as deceased donors.
Evidence of conjunctivitis
ARDS, Pneumonia or pulmonary computed tomography (CT) scanning showing
“ground-glass opacities”
62. Close contact is defined as
A) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of
time; close contact can occur while caring for, living with, visiting, or sharing a health care
waiting for area or room with a COVID-19 case;
B) having direct contact with infectious secretions of a COVID-19 case
63. Document the risk assessment of the deceased by taking a relevant history from attender
or family members
only corneal scleral rim excision be performed and avoid the whole eyeball enucleation.
Use Intermediate preservative media
Donor corneas in intermediate preservation media if not utilised should be shifted
to glycerol on the last day of preservation
Entire disposable PPE kit to be removed immediately after tissue retrieval, properly
packaged to avoid cross infection and disposed off after reaching the hospital.
Non-disposable parts of the PPE like goggles/visor to be cleaned with spirit or
sodium hypochlorite immediately after returning to the hospital
64. Clean all external surfaces of MK Medium/Cornisol bottles, Flask, ice Gel packs,
Instrument tray, SS Bin with Surgical spirit, alcohol wipes or freshly prepared
sodium hypochlorite after recovery and repeat it at Eye Bank.
CLEANING THE EYE BANK -
● The floor of the eye bank and laboratory areas MUST be cleaned with 1% Sodium
Hypochlorite every 2 hourly
● Deep Cleaning to be done anytime there is any contamination
● Door handles, side rails on stairs, high touch surface like- reception counter with
1 % Sodium Hypochlorite ( 4 Times /Day)
sodium pyruvate, glucose energetic sources low density amino acids, mineral salts nutrients trophic factors penicillin G, streptomycin, amphotericin B
antibiotics/antimycotic mixture
Hepes, bicarbonate buffers
phenol red pH indicator
purifi ed water solubilization of ingredients