Special thanx to K Muhammed Kunhi HOD of optometry Al Salama Eye Hospital Ltd

1. Recent Trends In Eye Banking

2. What is Eye Bank?
 An eye bank is non-profit motive
organization with a mission to
procure and provide donated human
eye tissue for sight restoring
transplantation procedures

3. What is Eye Bank?
“Eye bank is the link between the donor
family and a cornea recipient”

4. Milestones
 Edmund Zirm performed the first
successful corneal transplant in 1906
 1945 First eye bank established in
India at RIO, Madras

5. Milestones
 Stocker (1953) revealed the vital role
endothelial cells play in corneal
transparency
 1960 First successful corneal transplant
performed in India by Dr. R. P. Dhanda
and Dr. Kalevar

6.  In 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
 Kaufman et al (1985) presented K-Sol
as a storage method viable for up to 10
days
Milestones

7.  1989 Eye Bank Association of India
(EBAI) established
 1991: Optisol™ (Bausch & Lomb) was
developed as a storage medium that
lasts up to 14 days.
Milestones

8. Purpose of Eye Bank
1. Collection
2. Evaluation
3. Preservation
4. Distribution

9. 1. Collection
 Donor Screening
 Tissue Retrieval
 Collection of Blood (For Serological Test)
1. Collection
2. Evaluation
3. Preservation
4. Distribution

10. 1. Collection
 Donor Screening
Death Certificate
Legal Permission from Next of Kin (Consent)
Check for Medical Contraindications
1. Collection
2. Evaluation
3. Preservation
4. Distribution

11. 1. Collection
 Donor Screening
Contraindications
 Active viral Hepatitis
 Acquired immunodeficiency syndrome or HIV
 Active viral encephalitis
 Creutzfeldt-Jakob disease
 Rabies
1. Collection
2. Evaluation
3. Preservation
4. Distribution

12. 1. Collection
 Donor Screening
Contraindications
 Leukemia
 Reye’s Syndrome
 Active Tuberculosis
 Septicemia
 Death of unknown cause
1. Collection
2. Evaluation
3. Preservation
4. Distribution

13. 1. Collection
 Donor Screening
Eye disease or Conditions
 Retinoblastoma
 Previous Corneal Graft
 Photo Ablation
 Malignant tumors of the anterior ocular segment
 Active inflammation of eye at the time of death
Contraindications
1. Collection
2. Evaluation
3. Preservation
4. Distribution

14. 1. Collection
 Donor Screening
Not a Contraindication
 Cancer Patient
 Poor Vision or Blind
 Spectacle
 Too Old
 Previous Eye Surgeries
1. Collection
2. Evaluation
3. Preservation
4. Distribution

15. 1. Collection
 Tissue Retrieval
i. Whole Globe Enucleation
ii. In-Situ Excision of Corneo Scleral Rim
1. Collection
2. Evaluation
3. Preservation
4. Distribution

16. 1. Collection
 Whole Globe Enucleation
1. Collection
2. Evaluation
3. Preservation
4. Distribution

17. Whole Globe Enucleation
Disadvantages
 Occasional Blood ooze
 Corneal endothelium quality in enucleated eyes
deteriorates in 24 hours
 May Cause some Disfigurement
1. Collection
1. Collection
2. Evaluation
3. Preservation
4. Distribution

18. 1. Collection
In-Situ Excision of Corneo Scleral Rim
1. Collection
2. Evaluation
3. Preservation
4. Distribution

19. In-Situ Excision of Corneo Scleral Rim
1. Collection
Advantages
 No Bleeding
 Prolonged Viability to the tissue
 No Disfigurement
1. Collection
2. Evaluation
3. Preservation
4. Distribution

20. Purpose of Eye Bank
1. Collection
2. Evaluation
3. Preservation
4. Distribution

21. 2. Evaluation
 Slit Lamp Examination
 Serological testing
 Specular Microscopy
1. Collection
2. Evaluation
3. Preservation
4. Distribution

22. 2. Evaluation
 Slit Lamp Examination
5 Layers of Cornea
1. Epithelium (intact/defects / exposure / infection)
2. Bowmans Membrane
3. Stroma (clarity/cloudiness/ opacities)
4. Descimet’s Membrane (Folds – Degree & Location)
5. Endothelium
1. Collection
2. Evaluation
3. Preservation
4. Distribution

23. 2. Evaluation
 Serological Testing of Blood Sample
HIV
Hep B
Hep C
1. Collection
2. Evaluation
3. Preservation
4. Distribution

24. 2. Evaluation
 Specular Microscopy
Ultra Structural Evaluation of Endothelium
for it’s integrity and Viability
1. Collection
2. Evaluation
3. Preservation
4. Distribution

25. 2. Evaluation
 Specular Microscopy
As we know the endothelium has the main
role in maintaining corneal transparency
Success of Keratoplasty depend upon
adequate transplanting of Endothelium
1. Collection
2. Evaluation
3. Preservation
4. Distribution

26.  Morphology
Morphologically, endothelium is a single
layer of hexagonal cells of uniform size.
2. Evaluation
1. Collection
2. Evaluation
3. Preservation
4. Distribution

27. 2. Evaluation
 Specular Microscopy
1.Cell Density
2.Polymegathism
3.Polymorphism
1. Collection
2. Evaluation
3. Preservation
4. Distribution

28. 2. Evaluation
 Specular Microscopy
1.Cell Density – Number of Cells in 1mm2
Excellent = >3000/mm2
Very God = 3000 - 2500/mm2
Good = 2500 – 2000/mm2
Fair = 2000 – 1500/mm2
Poor = <1500
1. Collection
2. Evaluation
3. Preservation
4. Distribution

29. 2. Evaluation
 Specular Microscopy
2. Polymegathism – Difference in cell size
3. Polymorphism – Difference in cell Shape (Hexagonalism)
Normal Polymegathism & Polymorphism
1. Collection
2. Evaluation
3. Preservation
4. Distribution

30. Purpose of Eye Bank
1. Collection
2. Evaluation
3. Preservation
4. Distribution

31. Purpose of Eye Bank
3. Preservation
1. To maintain the endothelial viability and integrity so that an
optional number of viable endothelial cells remain attached to
the Descemet's membrane
2. To increase the duration of storage so that an efficient use of the
donor corneas can be made
Death to Preservation time – 6 to 8Hrs
1. Collection
2. Evaluation
3. Preservation
4. Distribution

32.  Short Term Storage
 Moist Chamber – Whole Globe (24-36Hrs)
 Intermediate time Storage
 M-K Medium (4 Days)
 K-Sol (8-10 Days)
 Optisol (14 Days)
 Long Term Storage
 Organ Culture (1 Month)
 Cryopreservation (6 Months)
3. Preservation
1. Collection
2. Evaluation
3. Preservation
4. Distribution

33. Purpose of Eye Bank
 Collection
 Evaluation
 Preservation
 Distribution

34. 4. Distribution
Use of Corneal Tissue
 Optical
 PKP to treat Corneal Blindness
 Therapeutic
 Corneal Ulcer
 Tectonic
 Maintain Shape of globe (Corneal Perforation)
 Cosmetic
 Restore normal appearance of cornea
1. Collection
2. Evaluation
3. Preservation
4. Distribution