Eye bank, eye donation

1. EYE BANKING

2. What is an Eye Bank ?

3. It is a non profit communityorganization
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.

4. Functions of eye bank

5. EYE BANK

6. THREE TIER
ORGANIZATION
An integrated system
involving athree-tier community
eye banking pyramid basedon the
infrastructure and manpower atall
levels
.
Thethree tiers proposed wereeye
donation centres, eye bank and
eye bank training centres.

7. EBTC (eye bank
training centre)
The top tier comprises of 5 Eyebanking
training centers(EBTC) responsible for
1.Tissue harvesting, processing &
distribution.
2.Creating public awareness.
3.Training and skill up-gradation of eye
banking personnel.

8. Eye
banks
Middle tier would comprise of a strong network
of45 EyeBanks(EB)
•cater to a population of 20 millioneach.
•would be closely linked with 2,000 EyeDonation
Centers- EDC(ratio of 1: 50 suggested)

9. EYE
DONATIO
N CENTERS
•Publicity of the voluntary 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.

10. Organisational
structure
•EB should be under the charge of a Medical
Director.
•Functions of Medical Director
• Maintains good communication with
regulatory council, enucleators, eye bank
personnel, and public.
•Key managerial person- Eye bank manager.
•Three technicians and grief counsellors.
•Min 600sq feet area

11. Equipment
Mandatory
•Refrigerator with temperature
recording device
•Biological safety cabinetor
operation theatre
• Slit lamp
• Sterilization facilities
•Enucleation andcorneal
excision instruments
Desirable
• Incubator
• Specularmicroscope
• Ultrasonic cleaner
• Ice machine
• Microbiology facilities
• Centrifuge

12. EYE BANK-SOURCES OF TISSUE
Voluntary
Police mortuaries
Hospital Cornea Retrieval
Program(HCRP)

13. STEPS OF EYE
DONATION
1. DONOR SELECTION
2. TISSUE RETRIEVAL
3. CORNEAL EXAMINATION
4. TISSUE TRANSPORTATION
5. STORAGE OF CORNEAL
TISSUE
6. DISTRIBUTION

14. 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

15. 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

16. Contraindications for
eye donation
I. Systemic Conditions potentially hazardous to eye bank personnel
and fatal, if transmitted:
a.HIV Seropositivity.
b.Rabies
c.Active viral hepatitis
d.Creutzfeldt-Jakob disease.
Other contraindications:
a.Subacute sclerosing panencephalitis
b.Progressive multifocal leukoencephalopathy
c.Reye’s syndrome
d.Death from unknown cause including unknown encephalitis
e.Congenital rubella
f.Active septicemia including endocarditis

17. II. Ocular
a.Intrinsic eye disease—retinoblastoma, active
inflammatory disease(conjunctivitis, iritis, uveitis,vitreitis,
retinitis), congenital abnormalities (keratoconus,
keratoglobus), central opacities andpterygium.
a.Prior refractive procedures—radial keratotomy
scars, lamellar inserts, laserphotoablation.
b.Anterior segment surgical procedures
(cataract, glaucoma).

18. TISSUE RETRIVAL
enucleation
i.e. surgical
removal of the wholeeye
by in -situ
corneo-scleral
excision
(globe isretained
In the orbit)

20. Enucleatio
n

22. Corneo – scleral
button excision

24. Biomicroscop
ic
Examination
Whole Globe Examination
•examined asearly aspossible before the
corneal edema increases.
•Thawed to room temperature for the
endothelium to function and deturgescence
the cornea.
•All handling of the globe should be done
with sterile instruments/cotton tipped
applicators

25. CORNEOSCLERAL BUTTON EXAMINATION
1.glass vial placed in aspecial corneal viewing
chamber
2.tissue warmed to roomtemperature
3.Slitlamp Biomicroscopic examination

27. •Epithelial microscytic oedema, defects and debris are tobe
looked for.
•Epithelial oedema is indicative of poor endothelialfunction.
•Epithelial oedema hasto be carefully differentiatedfrom
surface irregularity of the epithelium by oblique
illumination or retroilluminationtechniques.
Corneal Epithelium

28. Corneal stroma
The corneal stroma is screened for opacities,
infiltration, edema and Descemet's folds.

29. 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 .

30. Eye Bank -
Preservation Media
• Short Term (48hrs) - Moist Chamber
• Intermediate Term (4 days)-
McCarey - Kaufman medium – 4days
K- Solmedium - 7 days
Dexsol medium - 10days
Optisol medium - 14days
•Longterm storage - Organ Culture – 35days
Cryopreservation - 1year

31. Short term
storage
methods
1. Moist chamberstorage:
•Storage of the whole globe for short period of
time at 4degree
•It is aclosed container with cottongauze
moistened with sterilesaline
• Container is never completely filled withliquid

32. Advantages of moist chamberstorage
1.simplicity
2. needs little expertise &manipulation
3.inexpensive
Disadvantages
1.storage time limited to48 hrs
2. endothelium remains in contact withaqueous.

33. Intermediate term storage
methods
Tissuemedia preservation:
Advantages:
1.provides achemically defined & stable
environment
2.helps support & enhances metabolicactivities
3.reduces the stromalswelling
4.keeps the tissue under sterile condition tilluse
5.provides time for EBto serologically screenthe
donor for communicablediseases

34. INGREDIENT
S :
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

35. Dextran
• Keepspreserved cornea thin
•Initially 5% of 5,00,000mol wt dextran isused.
•In newer media 1%of 40000mol.Wt isused.
Chondroitin sulphate.
•it is akin to naturally occuring GAGincornea.
•It is available from whale(type A),wine(typeB),shark(typec).
•High mol.wt chondroitin sulphate maintains deturegence whereas
low mol.wt helps retain viability of endothelium
•Also acts asan antioxidant

36. MC CAREY KAUFMAN
MEDIUM
Components
Tic 199
5%dextran
Bicarbonate buffer
Penicillin and streptomycin which waslatersubstituted
by gentamycin in con of 50-200 micro grams perml

37. Modified MKmedium
•Waltman and plamberg
•Substituted 0.025 M hepes buffer for bicarbonate buffer
•phenol red asapHindicator
•Osmolarity 290 milli osm/kg
•pH 7.4
•Storage period 4 daysat 4 degreeC.

40. Chondroitinsulphateenriched media
K-solmedium:
Storage period 7days
Corneal storage medium:
•Minimal essentialmedium
•1.35 %chondroitin sulphate
•0.025 M hepesbuffer
•Mercaptoethnol
•Non essential amino acids
•gentamycin

41. Dexol medium :
•Composition similar alongwith antioxidants
•Storage period – 10days
•Optisol media :
•Described in 1991 by kaufman andassociates
•Contains both dextran and chondroitin sulphate toenhance
corneal dehydration
•Storage period is 14days
•Procell medium :
•Contains insulin ,HEGF
,Vit-B12 and anti-oxidants

43. LONG-TERM
STORAGE
1. Organ-culture method
2. Cryo preservation
1. Organ culture method
•
•
Up to 35days
Corneoscleral button is placed in petridish
containing 15ml of medium.

44. COMPONENTSOFORGANCUL
TUREMEDIUM
Eagle’sminimum essential medium
Earle’s salts without L-glutamine
L-glutamine
Decomplemented calf serum
1.5%chondroitin sulfate

45. 2.
CRYOPRESERVATION
•can be preserved for an indefinite period oftime
•Developed by CAPELLA and KAUFMAN
•Corneoscleral button is passedthrough aseriesof
solutions containing increasing concentraions of
DIMETHYL SULFOXIDE(DMSO)upto7.5%
•It acts asmembrane stabilizer
•frozen at acontrolled rate upto -80deg C
•subsequently stored at -180 degC

46. Advantages of cryopreservation
•emergency situations like corneal trauma andperforation
•for performing bacteriological studies on donortissue and HLA
compatability studies
•Disadvantages
•Needsexpensive equipment and highly trained persons

47. Other uses:
Donated Sclera can be used for glaucoma ,
oculoplastic and retinal surgeries
Fair and equitable distribution of transplantable
tissues to corneal surgeons acco to waiting list.

48. 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.

49. 1.Enucleating doctors always have to legally
obtain a written consent from the relatives of
the deceased before they actually remove the
eyes.