Eye banking and corneal transplantation 10.03.16,dr.k.n.jha

1. Dr. K N Jha, MS
Professor of Ophthalmology
Email: kirtinath.jha@gmail.com

2. Eye Bank
• An "Eye Bank" is a not for profit community organisation
governed by a Board of Directors or Trustees constituted
by community representatives.
It is the link between donor and recipient/eye surgeon.
It is an organization recognized by the government to
collect and distribute human eyes to those requiring
corneal transplantation.

3. Structure
Medical section : Medical Director ( A qualified
Corneal Surgeon), Trained technicians
Administrative Section: Eye Donation Counsellor /
Social Worker / Health Educator / Clerk

4. Functions of the Administrative Section
The administrative section is responsible for
- Public awareness programmes
- Liaison with government, local voluntary and other
health care agencies
- Fund raising

5. Functions of the Medical Section
Medical section deals with the entire technical
operation of the eye bank:
-Tissue harvesting, tissue evaluation, tissue
preservation, tissue distribution following
medical quality of highest standard.

6. Functions of the Eye Bank
Networking of eye banks under the umbrella
of a national organisation( e.g. Eye Bank Association of
India) allows
-Public education programmes
- Institution of newer eye banking procedures
- Training programmes and development of
uniform medical standards

7. Requirements
• Communication facilities( telephone)
• Equipments such as slit lamp and laminar flow hood,
surgical instruments, sterilisation facilities, serology
laboratory, preservation media and appropriate
transportation system.
• Round the clock coverage by fully trained technicians
• Nationwide network to facilitate optimal utilisation
of all corneas.

8. Eye Banking Standards
Directorate General of Health Services( DGHS),
Ministry of Health & Family Welfare, Government of
India has laid down standards of Eye banking in India.

9. Pledge and Consent
Family pledge for eye donation
Consent from the next of kin

10. Problems of Eye Banking
Information and accessibility
Medical issues/ contraindication
Climatic factors
Cultural and religious issues

11. Retrieval
Retrieval by Medical officer or a trained paramedic
The instruments
Methods: whole eyeball/ sclero-corneal button

12. Cornea Processing
Disinfection
Slit lamp examination and classification
Processing under laminar airflow

13. Corneal Storage
Short-term storage : MKK Medium
Intermediate term storage
Long-term storage

14. Distribution of Cornea
Distribution to only hospitals and ophthalmologists
registered under HOTA
Maintenance of waiting list
Distribution record
Feedback from the hospital receiving cornea

15. Eye Bank Association of India( EBAI)
EBAI is a not for profit society.
Any person / organization can become a member
A national organization acting as a resource center.
Objectives : increase collection of eyes, introduce
uniform standards in eye banks and to educate public
about eye donation and prevention of corneal
blindness.

16. Summary
What is an Eye bank ?
Eye Donation: Pledge, consent, collection,
processing , and distribution
Human Organ Transplantation Act ( HOTA)

17. ( Keratoplasty)

18. 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)

19. Corneal Transplantation
:Schematic

20. Types of Keratoplasty
Optical – to improve vision
Tectonic- to restore or preserve corneal integrity
Therapeutic- to remove infected corneal tissue
Cosmetic- to improve appearance

21. Keratoplasty : Schematic Diagram

22. Indications of Penetrating Keratoplasty( PK)
Keratoconus
Post- cataract surgery edema
Corneal dystrophies and degenerations
Mechanical or chemical trauma
Microbial/postmicrobial keratitis
Congenital opacity

23. Corneal Opacity

24. Vascularised Corneal Opacity

25. Preoperative Evaluation
Systemic evaluation
A complete eye examination
Examination of the ocular adnexa

26. Surgical Technique
Determination of graft size
Excision of donor cornea
Excision of diseases host cornea
Fixation of donor button
Removal of viscoelastic substance

27. Removal of Corneal Button

28. Corneal Transplant

29. 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

30. Postoperative Care
Topical steroids and antibiotics
Mydriatic
Oral antiviral
Removal of suture
Rigid contact lens for residual astigmatism

31. Post operative Complications
Infection
Suture dehiscence
Corneal allograft rejection ( epithelial/ stromal/
endothelial)
Secondary glaucoma

32. Prognostic factors
Abnormalities of eyelid
Tear film function
Recurrent and progressive conjunctival
Inflammation
Stromal vascularisation
Uveitis and anterior synechia
Uncontrolled glaucoma

33. 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

34. Types of Lamellar Keratoplasty
Superficial/ Deep anterior lamellar keratoplasty
( SALK/DALK)
Descemet stripping automated endothelial
keratoplasty (DSAEK)
Descemet membrane Endothelial Keratoplasty
(DMEK)

35. Anterior Lamellar Keratoplasty

36. Triple Procedure
Cataract extraction
Intraocular lens implantation
Corneal transplantation

37. FREQUENTLY ASKED QUESTIONS
What is an Eye Bank ?
What is meant by corneal transplantation?
How is the tissue harvested from a donor?
How quickly should the corneas/eyes be removed
after death?

38. FREQUENTLY ASKED QUESTIONS
Is it necessary to transport the donor to the hospital
after death for donating eyes?
How will the donated eyes be used?
Does the human body reject the transplanted donor
cornea?

39. FREQUENTLY ASKED QUESTIONS
What conditions render corneas unfit for donations?
Do cataracts or the use of spectacles render the
corneas unfit?
What about diabetes or hypertension?

40. FREQUENTLY ASKED QUESTIONS
Does eye donation disfigure the donor’s face?
Is there any use of corneas that are for some reason
not utilised for surgery?
Do religious authorities approve of donating one’s
eyes?.

41. FREQUENTLY ASKED QUESTIONS
Will the donor or recipient family be told who
donated or received the cornea?
Will the donor family be given fees?
Is there any delay in funeral arrangements?

42. Points to Remember
Definition of keratoplasty
Indications
Methods
Complications of keratoplasty
Prognosis of keratoplasty
Recent advances