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EYE BANK
MUHAMMED FASAL
OVERVIEW
 INTRODUCTION
 FUNCTIONS
 CONTRAINDICATIONS
 STEPS OF EYE DONATION
 RATING OF CORNEA
 STORAGE
 DISTRIBUTION
 CORNEAL TRANSPLANTATION
 LEGAL ASPECTS IN INDIA
What is an Eye Bank
?
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.
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.
EBTC (EYE BANK TRAINING CENTRE)
The top tier comprises of 5 Eye banking training
centers (EBTC)
responsible for
1. Tissue harvesting, processing & distribution.
2. Creating public awareness.
3. Training and skill up-gradation of eye banking
personnel.
EYE BANKS
 Middle tier would comprise of a strong network of 45
Eye Banks(EB)
• cater to a population of 20 million each.
• would be closely linked with 2,000 Eye Donation
Centers- EDC (ratio of 1: 50 suggested)
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
• would cater to a population ranging from 50,000 to
100,000.
FUNCTIONS OF EYE BANK
Recovery
or retrieval
Cornea
Processing
Distribution
How It Works ?
TISSUE RETRIEVAL
 Contraindications:
Systemic:
• AIDS
• Rabies
• Active viral hepatitis
• Creutzfeldt-Jakob disease
• SSPE
• Death from unknown
causes
• Congenital Rubella
• Active septicemia
• High risk behavioral
features
• Leukemia (blast form)
• Lymphoma/
lymphosarcoma
Ocular:
• Intrinsic eye
diseases
 Retinoblastoma
 Active
conjunctivitis , iritis
, uveitis , vitreitis,
retinitis
 Congenital
abnormalities
(keratoconus)
 Central opacities,
pterygeum
• Prior refractive
procedures (radial
keratotomy scar,
lamellar inserts)
STEPS OF EYE DONATION
1. Donor selection
2. Tissue retrieval
3. Corneal examination
4. Tissue transportation
5. Storage of corneal tissue
6. Distribution
DONOR SELECTION
1) AGE OF DONOR:
no influence of age on transplant outcome.
Older age : usage rate declines
Lower limit : 2 yrs to prevent myopic shift after
keratoplasty
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
TISSUE RETRIVAL
enucleation
i.e. surgical by in -situ
removal of the whole eye corneo-
scleral
excision
(globe
is retained
In the orbit)
PRELIMINARY PREPARATIONS
 Obtain legal permission.
 Go through the donor’s medical records for any
contraindications.
 Wash hands and be prepared with aseptic dressing,
draping etc.
 Identify the donor.
 Collection of postmortem blood:10ml
 Femoral vein
 Subclavian vein
 Heart
 Jugular vein
ENUCLEATION
CORNEOSCLERAL BUTTON EXCISION
EVALUATION OF THE DONOR TISSUE
 Gross examinations:
 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
media is to be noted. Yellowish
colour-acidic media-
contamination.
EVALUATION OF DONOR TISSUE
 Biomicroscopic examination:
Rate criteria
1 (excellent) 1. No epithelial defects
2. Crystal clear stroma
3. No arcus senilis
4. No folds in descemet’s membrane
5. Endotheleum-no defects
2 (very good) 1. Slight epitheal haze/defects
2. Clear stroma
3. Very slight arcus
4. Few folds in descemet
5. Endotheleum-no defects
3 (good) 1. Moderate epi. Defects
2. Moderate stromal cloudyness
3. Arcus < 2.5mm
4. Numerous but shallow folds
5. Few vacuolated cells in endotheleum
4 (fair) 1. Epitheleal defects ˃ 60%
2. Mod to heavy stromal cloudiness
3. Numerous deep descemet’s folds
4. Arcus ˃ 2.5mm
5. Low endotheleal cell density
Poor 1. Central epitheleal defects
2. Heavy stromal cloudyness
3. Marked folds
4. Marked endotheleal cellular defects
STORAGE OF DONOR TISSUE
storage
Short term
2-3days
Moist chamber
(24hrs),M-K
medium
Intermediate
7-10days
K-sol, Dexol,
Optisol, Optisol GS
Long term
30days
Organ culture
medium,MEM
Very long term
1year
Cryopreservation
METHODS OF CORNEAL
PRESERVATI0N
1. Short-term storage methods
2. Intermediate-term storage
3. Long term storage
EYE BANK - PRESERVATION MEDIA
• Short Term (48hrs) - Moist Chamber
• Intermediate Term (4 days) -
 McCarey - Kaufman medium – 4 days
 K - Sol medium - 7 days
 Dexsol medium - 10 days
 Optisol medium - 14 days
• Long term storage - Organ Culture – 35
days
 Cryopreservation - 1 year
SHORT TERM STORAGE METHODS
1. Moist chamber storage:
• Storage of the whole globe for short period of
time at 4 degree
• It is a closed container with cotton gauze
moistened with sterile saline
• Container is never completely filled with
liquid
Advantages of moist chamber storage
1.simplicity
2. needs little expertise & manipulation
3.inexpensive
Disadvantages
1.storage time limited to 48 hrs
2. endothelium remains in contact with aqueous.
INTERMEDIATE TERM STORAGE
METHODS
Tissue media preservation:
Advantages:
1.provides a chemically defined & stable
environment
2.helps support & enhances metabolic activities
3.reduces the stromal swelling
4.keeps the tissue under sterile condition till use
5.provides time for EB to serologically screen
the donor for communicable diseases
INGREDIENTS :
1.Dextran
2.Chondroitin sulphate
3.Electrolytes
4.pH buffer system
5.Antibiotics
6.Essential aminoacids
7.Antioxidants,ATP precursors
8.Insulin
9.EGF
10.ANTIPROTEASES & anticollagenases
Dextran
• Keeps preserved cornea thin
• Initially 5% of 5,00,000 mol wt dextran is used.
• In newer media 1% of 40000mol.Wt is used.
Chondroitin sulphate.
• it is akin to naturally occuring GAG in cornea.
• It is available from whale(type A),wine(typeB),shark(type c).
• High mol.wt chondroitin sulphate maintains deturegence
where as low mol.wt helps retain viability of endothelium
• Also acts as an antioxidant
MC CAREY KAUFMAN MEDIUM
Components
 Tic 199
 5% dextran
 Bicarbonate buffer
 Penicillin and streptomycin which was later
substituted by gentamycin in con of 50-200 micro
grams per ml
Modified MK medium
• Waltman and plamberg
• Substituted 0.025 M hepes buffer for bicarbonate buffer
• phenol red as a pH indicator
• Osmolarity 290 milli osm/kg
• pH 7.4
• Storage period 4 days at 4 degree C.
SNAIL TRACKS, STRESS STRIAE CARELESS
 The middle and lower
illustrations show snail
tracks at varying degrees
of magnification.
 Careless folding of the
corneal cap during
removal causes snail
tracks .
DISTRIBUTION OF CORNEA
 Distribution to only hospitals and ophthalmologists
registered under HOTA
 Maintenance of waiting list
 Distribution record
 Feedback from the hospital receiving cornea
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.
CORNEAL TRANSPLANTATION
 ( Keratoplasty)
CORNEAL TRANSPLANTATION
 Corneal transplantation refers to surgical replacement of a full-
thickness or lamellar portion of the host cornea with that of a
donor eye.
 Allograft/autograft
 Full-thickness( Penetrating)/ Partial thickness ( lamellar)
CORNEAL TRANSPLANTATION :SCHEMATIC
TYPES OF KERATOPLASTY
 Optical – to improve vision
 Tectonic- to restore or preserve corneal integrity
 Therapeutic- to remove infected corneal tissue
 Cosmetic- to improve appearance
KERATOPLASTY : SCHEMATIC DIAGRAM
INDICATIONS OF PENETRATING KERATOPLASTY(
PK)
 Keratoconus
 Post- cataract surgery edema
 Corneal dystrophies and degenerations
 Mechanical or chemical trauma
 Microbial/postmicrobial keratitis
 Congenital opacity
CORNEAL OPACITY
VASCULARISED CORNEAL OPACITY
PREOPERATIVE EVALUATION
 Systemic evaluation
 A complete eye examination
 Examination of the ocular adnexa
SURGICAL TECHNIQUE
 Determination of graft size
 Excision of donor cornea
 Excision of diseases host cornea
 Fixation of donor button
 Removal of viscoelastic substance
REMOVAL OF CORNEAL BUTTON
CORNEAL TRANSPLANT
INTRAOPERATIVE COMPLICATIONS
 Damage to the lens and/or iris
 Irregular trephine
 Poor graft centration
 Excessive bleeding from the iris and wound edge
 Choroidal hemorrhage
 Iris incarceration in the wound
 Damage to the donor endothelium
POSTOPERATIVE CARE
 Topical steroids and antibiotics
 Mydriatic
 Oral antiviral
 Removal of suture
 Rigid contact lens for residual astigmatism
POST OPERATIVE COMPLICATIONS
 Infection
 Suture dehiscence
 Corneal allograft rejection ( epithelial/ stromal/
endothelial)
 Secondary glaucoma
PROGNOSTIC FACTORS
 Abnormalities of eyelid
 Tear film function
 Recurrent and progressive conjunctival
 Inflammation
 Stromal vascularisation
 Uveitis and anterior synechia
 Uncontrolled glaucoma
LAMELLAR KERATOPLASTY
 Lamellar keratoplasty refers to replacement of only a
portion of the corneal layers of the host cornea with the
graft.
 Indications:
-Opacification of superficial corneal stroma
-Marginal thinning or infiltration
-Localised thining / descematocele formation
TYPES OF LAMELLAR KERATOPLASTY
 Superficial/ Deep anterior lamellar keratoplasty (
SALK/DALK)
 Descemet stripping automated endothelial keratoplasty
(DSAEK)
 Descemet membrane Endothelial Keratoplasty (DMEK)
ANTERIOR LAMELLAR KERATOPLASTY
TRIPLE PROCEDURE
 Cataract extraction
 Intraocular lens implantation
 Corneal transplantation
LEGAL ASPECTS IN INDIA
Under the Transplantation of Human Organs Act,
1994 (THOA)
1. The qualification of doctors permitted to perform
enucleation (surgical eye removal) has been
reduced 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 before they actually remove the eyes.
Don't Burn or Bury
Your Eyes.....
Help Others See Our
Beautiful World Too!
Eye bank

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Eye bank

  • 2. OVERVIEW  INTRODUCTION  FUNCTIONS  CONTRAINDICATIONS  STEPS OF EYE DONATION  RATING OF CORNEA  STORAGE  DISTRIBUTION  CORNEAL TRANSPLANTATION  LEGAL ASPECTS IN INDIA
  • 3. What is an Eye Bank ?
  • 4. 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.
  • 5. 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.
  • 6. EBTC (EYE BANK TRAINING CENTRE) The top tier comprises of 5 Eye banking training centers (EBTC) responsible for 1. Tissue harvesting, processing & distribution. 2. Creating public awareness. 3. Training and skill up-gradation of eye banking personnel.
  • 7. EYE BANKS  Middle tier would comprise of a strong network of 45 Eye Banks(EB) • cater to a population of 20 million each. • would be closely linked with 2,000 Eye Donation Centers- EDC (ratio of 1: 50 suggested)
  • 8. 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 • would cater to a population ranging from 50,000 to 100,000.
  • 11. TISSUE RETRIEVAL  Contraindications: Systemic: • AIDS • Rabies • Active viral hepatitis • Creutzfeldt-Jakob disease • SSPE • Death from unknown causes • Congenital Rubella • Active septicemia • High risk behavioral features • Leukemia (blast form) • Lymphoma/ lymphosarcoma Ocular: • Intrinsic eye diseases  Retinoblastoma  Active conjunctivitis , iritis , uveitis , vitreitis, retinitis  Congenital abnormalities (keratoconus)  Central opacities, pterygeum • Prior refractive procedures (radial keratotomy scar, lamellar inserts)
  • 12. STEPS OF EYE DONATION 1. Donor selection 2. Tissue retrieval 3. Corneal examination 4. Tissue transportation 5. Storage of corneal tissue 6. Distribution
  • 13. DONOR SELECTION 1) AGE OF DONOR: no influence of age on transplant outcome. Older age : usage rate declines Lower limit : 2 yrs to prevent myopic shift after keratoplasty
  • 14. 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
  • 15. TISSUE RETRIVAL enucleation i.e. surgical by in -situ removal of the whole eye corneo- scleral excision (globe is retained In the orbit)
  • 16. PRELIMINARY PREPARATIONS  Obtain legal permission.  Go through the donor’s medical records for any contraindications.  Wash hands and be prepared with aseptic dressing, draping etc.  Identify the donor.  Collection of postmortem blood:10ml  Femoral vein  Subclavian vein  Heart  Jugular vein
  • 19. EVALUATION OF THE DONOR TISSUE  Gross examinations:  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 media is to be noted. Yellowish colour-acidic media- contamination.
  • 20. EVALUATION OF DONOR TISSUE  Biomicroscopic examination:
  • 21. Rate criteria 1 (excellent) 1. No epithelial defects 2. Crystal clear stroma 3. No arcus senilis 4. No folds in descemet’s membrane 5. Endotheleum-no defects 2 (very good) 1. Slight epitheal haze/defects 2. Clear stroma 3. Very slight arcus 4. Few folds in descemet 5. Endotheleum-no defects 3 (good) 1. Moderate epi. Defects 2. Moderate stromal cloudyness 3. Arcus < 2.5mm 4. Numerous but shallow folds 5. Few vacuolated cells in endotheleum 4 (fair) 1. Epitheleal defects ˃ 60% 2. Mod to heavy stromal cloudiness 3. Numerous deep descemet’s folds 4. Arcus ˃ 2.5mm 5. Low endotheleal cell density Poor 1. Central epitheleal defects 2. Heavy stromal cloudyness 3. Marked folds 4. Marked endotheleal cellular defects
  • 22. STORAGE OF DONOR TISSUE storage Short term 2-3days Moist chamber (24hrs),M-K medium Intermediate 7-10days K-sol, Dexol, Optisol, Optisol GS Long term 30days Organ culture medium,MEM Very long term 1year Cryopreservation
  • 23. METHODS OF CORNEAL PRESERVATI0N 1. Short-term storage methods 2. Intermediate-term storage 3. Long term storage
  • 24. EYE BANK - PRESERVATION MEDIA • Short Term (48hrs) - Moist Chamber • Intermediate Term (4 days) -  McCarey - Kaufman medium – 4 days  K - Sol medium - 7 days  Dexsol medium - 10 days  Optisol medium - 14 days • Long term storage - Organ Culture – 35 days  Cryopreservation - 1 year
  • 25. SHORT TERM STORAGE METHODS 1. Moist chamber storage: • Storage of the whole globe for short period of time at 4 degree • It is a closed container with cotton gauze moistened with sterile saline • Container is never completely filled with liquid
  • 26. Advantages of moist chamber storage 1.simplicity 2. needs little expertise & manipulation 3.inexpensive Disadvantages 1.storage time limited to 48 hrs 2. endothelium remains in contact with aqueous.
  • 27. INTERMEDIATE TERM STORAGE METHODS Tissue media preservation: Advantages: 1.provides a chemically defined & stable environment 2.helps support & enhances metabolic activities 3.reduces the stromal swelling 4.keeps the tissue under sterile condition till use 5.provides time for EB to serologically screen the donor for communicable diseases
  • 28. INGREDIENTS : 1.Dextran 2.Chondroitin sulphate 3.Electrolytes 4.pH buffer system 5.Antibiotics 6.Essential aminoacids 7.Antioxidants,ATP precursors 8.Insulin 9.EGF 10.ANTIPROTEASES & anticollagenases
  • 29. Dextran • Keeps preserved cornea thin • Initially 5% of 5,00,000 mol wt dextran is used. • In newer media 1% of 40000mol.Wt is used. Chondroitin sulphate. • it is akin to naturally occuring GAG in cornea. • It is available from whale(type A),wine(typeB),shark(type c). • High mol.wt chondroitin sulphate maintains deturegence where as low mol.wt helps retain viability of endothelium • Also acts as an antioxidant
  • 30. MC CAREY KAUFMAN MEDIUM Components  Tic 199  5% dextran  Bicarbonate buffer  Penicillin and streptomycin which was later substituted by gentamycin in con of 50-200 micro grams per ml
  • 31. Modified MK medium • Waltman and plamberg • Substituted 0.025 M hepes buffer for bicarbonate buffer • phenol red as a pH indicator • Osmolarity 290 milli osm/kg • pH 7.4 • Storage period 4 days at 4 degree C.
  • 32.
  • 33. SNAIL TRACKS, STRESS STRIAE CARELESS  The middle and lower illustrations show snail tracks at varying degrees of magnification.  Careless folding of the corneal cap during removal causes snail tracks .
  • 34. DISTRIBUTION OF CORNEA  Distribution to only hospitals and ophthalmologists registered under HOTA  Maintenance of waiting list  Distribution record  Feedback from the hospital receiving cornea
  • 35. 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.
  • 37. CORNEAL TRANSPLANTATION  Corneal transplantation refers to surgical replacement of a full- thickness or lamellar portion of the host cornea with that of a donor eye.  Allograft/autograft  Full-thickness( Penetrating)/ Partial thickness ( lamellar)
  • 39. TYPES OF KERATOPLASTY  Optical – to improve vision  Tectonic- to restore or preserve corneal integrity  Therapeutic- to remove infected corneal tissue  Cosmetic- to improve appearance
  • 41. INDICATIONS OF PENETRATING KERATOPLASTY( PK)  Keratoconus  Post- cataract surgery edema  Corneal dystrophies and degenerations  Mechanical or chemical trauma  Microbial/postmicrobial keratitis  Congenital opacity
  • 44. PREOPERATIVE EVALUATION  Systemic evaluation  A complete eye examination  Examination of the ocular adnexa
  • 45. SURGICAL TECHNIQUE  Determination of graft size  Excision of donor cornea  Excision of diseases host cornea  Fixation of donor button  Removal of viscoelastic substance
  • 48. INTRAOPERATIVE COMPLICATIONS  Damage to the lens and/or iris  Irregular trephine  Poor graft centration  Excessive bleeding from the iris and wound edge  Choroidal hemorrhage  Iris incarceration in the wound  Damage to the donor endothelium
  • 49. POSTOPERATIVE CARE  Topical steroids and antibiotics  Mydriatic  Oral antiviral  Removal of suture  Rigid contact lens for residual astigmatism
  • 50. POST OPERATIVE COMPLICATIONS  Infection  Suture dehiscence  Corneal allograft rejection ( epithelial/ stromal/ endothelial)  Secondary glaucoma
  • 51. PROGNOSTIC FACTORS  Abnormalities of eyelid  Tear film function  Recurrent and progressive conjunctival  Inflammation  Stromal vascularisation  Uveitis and anterior synechia  Uncontrolled glaucoma
  • 52. LAMELLAR KERATOPLASTY  Lamellar keratoplasty refers to replacement of only a portion of the corneal layers of the host cornea with the graft.  Indications: -Opacification of superficial corneal stroma -Marginal thinning or infiltration -Localised thining / descematocele formation
  • 53. TYPES OF LAMELLAR KERATOPLASTY  Superficial/ Deep anterior lamellar keratoplasty ( SALK/DALK)  Descemet stripping automated endothelial keratoplasty (DSAEK)  Descemet membrane Endothelial Keratoplasty (DMEK)
  • 55. TRIPLE PROCEDURE  Cataract extraction  Intraocular lens implantation  Corneal transplantation
  • 56. LEGAL ASPECTS IN INDIA Under the Transplantation of Human Organs Act, 1994 (THOA) 1. The qualification of doctors permitted to perform enucleation (surgical eye removal) has been reduced 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 before they actually remove the eyes.
  • 57.
  • 58. Don't Burn or Bury Your Eyes..... Help Others See Our Beautiful World Too!

Editor's Notes

  1. Eye banking services basically involves three steps. First is the recovery or retrieval of corneas from the deceased. Then these corneas are processed and examined. In the last step processed cornea, those are found to be suitable for transplantation are distributed as per requirement of in house cornea surgeons, or to other centers.