An eye bank is a nonprofit organization that retrieves, processes, stores and distributes donor corneal tissue for transplantation. Corneal blindness is a major problem in developing countries that can often be addressed through corneal transplantation, which has a high success rate. In India, the number of corneal transplants has been increasing but still does not meet the need, with over 50% of tissue coming from a few states. Eye banks are responsible for properly evaluating donor tissue through testing, examination and microscopy before distributing it to ensure safe and effective transplantation. Tissue is stored short or long-term in special nutrient media depending on preservation needs.

1. Dr.Puskar Ghosh
Final year PGT
BMC
EYE BANKING

2. DEFINITION:
• An "Eye Bank" is a not for profit community organisation
governed by a Board of Directors or Trustees constituted by
community representatives.
• Where safe quality donor eyes are procured,processed and
distributed for therapeutic use and research.

3. CORNEA AS TRANSPLANT:
• Imune privilage 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,replaced with minor peptides
 Expression of T-cell deleating legand on
endotheleum→apoptosis of killer T cells.
 Immunosupressive microenvironment of aqueous humor.
 Anterior chamber associated immune deviation.

4. MAGNITUDE OF THE PROBLEM
Corneal blindness is a major form of visual deprivation in
developing countries. A high percentage of these individuals can be
visually rehabilitated by corneal transplantation, a procedure that
has very high rate of success among organ transplants.
• trachoma,
• corneal ulceration,
• xerophthalmia,
• ophthalmia neonatarum,
• traditional eye medicines,
• onchocerciasis,
• leprosy, and
• ocular trauma

5. THE SCENARIO IN INDIA*
Year Tissue retrieved transplantation
2000 18,641 4381
2008 34520 9509
• Trend is increasing.
• Target: annual tissue retrieval 200,000/year
annual transplantation 100,000/year.
• ˃ 50% of tissue retrieval :
 Tamilnadu,
 Gujarat,Maharashtra,
 Andhra Pradesh,
 Karnataka
• West bengal-
 Collection-1688
 Utilization-489
*JIMSA July - September 2010 Vol. 23 No. 3

7. Eye Banking System
Eye Donation Center (EDC)
• affiliated to a registered eye bank
(1) public and professional awareness about eye donation
(2) co-ordinate with donor families and hospitals to motivate eye donation
(3) to harvest corneal tissue and collect blood for serology
(4) to ensure safe transportation of tissue to the parent eye bank.
Eye Bank (EB):
• Provide a round-the-clock public response system over the telephone and conduct public
awareness programmes on eye donation.
• Co-ordinate with donor families and hospitals to motivate eye donation/Hospital Cornea
Retrieval Pgramme – (HCRP)
• To harvest corneal tissue
• To process, preserve and evaluate the collected tissue
• To distribute tissue in an equitable manner for Keratoplasty
• To ensure safe transportation of tissue
Eye Bank Training Centre (EBTC)
• All of the eye bank functions plus training for all levels of personnel in eye banking and
research.

8. STRUCTURE AND FUNCTION:
• Relative autonomous,voluntary community based and
networked set up.
• Located either in large hospital set up or central neutral non
profit organizations.
MANPOWER EYE BANK
TRAINING CENTER
EYE BANK EYE DONATION
CENTER
Board of diorectors Yes Yes No
Medical director Yes Yes No
Executive director Yes Yes No
Eye bank manager Yes Yes Yes
Eye bank technicians Yes Yes Yes
Eye donation
councelor
Yes Yes No
Administrative
secretary
Yes Yes no
Telephone operators Yes Yes No
Registered medical
practitioners to
eneucleate round the
clock
Yes Yes yes

9. EQUIPMENTS:
EQUIPMENTS EBTC EB EDC
Slit lamp Required Required Not required
Refrigerators Required Required Preferable
Serology Required Required Not required
Specular microscope Required Required if collection is
˃ 200/yr
Not required
Instruments for corneal
exision
Required Required Required
Autoclave Required Required Should have access
Laminar flow hood Required Required Required

10. Recovery or
retrieval
Cornea
Processing
Distribution
How It Works ?

12. Retrieval/ Recovery of tissue
Deceased family calls Eye Bank
Grief counselor motivates
and obtains consent

13. TISSUE RETRIEVAL
• Contraindications:
Systemic:
• AIDS
• Rabies
• Active viral hepatitis
• Creutzfeldt-Jakob disease
• SSPE
• Progressive multifocal
leukoenchephalopathy
• Reye’s syndrome
• Death from unknown causes
• Congenital Rubella
• Active septicemia
• High risk behavioral features
• Leukemia (blast form)
• Lymphoma/lymphosarcoma
Ocular:
• Intrinsic eye diseases
 Retinoblastoma
 Active
conjuctivitis,iritis,uveitis
,vitreitis,retinitis
 Congenital
abnormalities
(keratoconus)
 Central
opacities,pterygeum
• Prior refractive
procedures (radial
keratotomy
scar,lamellar inserts)

14. 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

15. ENUCLEATION

16. CORNEOSCLERAL BUTTON EXCISION

17. SEROLOGICAL TESTING
• HIV
• HBV
• HCV
• HTLV
I&II
• Syphilis

18. EVALUATION OF THE DONOR TISSUE
• Gross examinations:
 Whole globe:
eyes with excessive stromal
hydration should be discarded unless
specular microscopy can be done for
endotheleal cell count.
 Corneoscleral button:
colour of the tissue storage
media is to be noted.Yellowish colour-
acidic media-contamination.

19. EVALUATION OF DONOR TISSUE
• Biomicroscopic examination:

20. EPITHELEUM:
• Location,extent,depth
• Abrasion,laceration,FB
• microcystic changes,
• dry area
• Haze,
• exposure,
• sloughing

21. BOWMAN’S LAYER
• Any defect
• Corneal laceration by
focusing a hairline slit
Reforms at deeper
level-defect is
apparent,minimal
Does’nt reforms-
Bowman’s membrane
involved

22. STROMA
• Hairline slit 15-20
degrees
• See the epitheleal and
endotheleal reflexes
Converge
centrally,diverge
peripherally-no
significant edema
Nearly parallel or
diverge centrally-
edema

23. ARCUS SENILIS
• Evident within central
8mm of the cornea

24. DESCEMET’S
MEMBRANE
• The severity of the folds-
width of the folds and the
amount of endothelial
area that they obscure
from view.

25. ENDOTHELiUM
• Seen by specular reflection,high
magnification
• Uniformity
• Size
• Shape
• Integrity.
• Presense of guttata,vacuolated
cells

26. EVALUATION OF DONOR TISSUE
• SPECULAR MICROSCOPY:
 Examine in room temperature
 1hr is allowed in room
temperature
 Within 1hr of recovery-examine
without refrigeration
 Warming cooling cycle-3times

27. EVALUATION OF DONOR TISSUE
Corneal Endotheleum:

28. ENDOTHELIAL CELL COUNT*
AGE Average
Endothelial cell
count
10-19 2,900-3,500
20-29 2,600-3,400
30-39 2,400-3,200
40-49 2,300-3,100
50-59 2,100-2,900
60-69 2,000-2,800
70-79 1,800-2,600
80-89 1,500-2,300
Critical cell density:
300-500 cells/mm2
Functional cell density:
1500-2200 cells/mm2
*Edelhauser HF. The balance between corneal transparency and edemathe Proctor Lecture. Invest Ophthalmol Vis Sci 2006
May;47(5):1754-67.
Philips C, Laing R, Yee R. Specular Microscopy. In: Krachmer JH, Mannis MJ, Holland EJ (eds). Cornea, 2nd ed. Philadelphia:
Elsevier Mosby, 2005:261-77.

29. EXCLUSION CRITERIA FOR PENETRATING
KERATOPLASTY*
• Cell density less than 2000 cells per square millimeter. Corneas
with cell density less than 2000 cells / sq. mm may be suitable
for lamellar procedures.
• Extreme polymegathism or pleomorphism.
• Presence of significant guttata.
• Presence of many non-hexagonal or abnormally shaped cells.
• Presence of inflammatory cells, bacteria, or debris on
endothelial surface.
• Numerous vacuolated cells.
*Standards of Eye banking in India 2009;NPCB;Director General of Health & Family Welfare,Govt.
of India

30. Parameters
Clarity
Epitheleal defects
Epitheleal edema
Scars
Foreign bodies
Stromal edema
Opaque infiltrate
Keratic precipitate
Arcus senilis
Folds
Guttata
Jaundice
Endotheleal cell count
CORNEAL VIABILITY

31. 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

32. 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

33. PRESERVATION OF CORNEA
• Moist chamber storage
 Storage of whole globe
 4◦C
 24 hours
• Advantage:simple
• Disadvantage:Corneal
stromal edema.

34. PRESERVATION OF CORNEA
• Tissue Media
o Dextran
o Chondroitin sulphate
o Electrolytes
o pH buffer system
o Antibiotics
o Essential amino acids
o Antioxidants,ATP precursors
o Insulin
o Epidermal growth factor
o Antiprotease,anticoagulants
Cornea storage
Media
Storage time (days)
MK 4
K-SOL 7
CSM 7
DEXSOL 10
OPTISOL 14
PROCELL 14

35. M-K medium:
• Described by Mc Caray & Kauffman.
• Mixture of tissue culture medium (TC-199) and Dextran (5%,40,000 MW)
• Buffer:HEPES (N hydroxyethyle piperazine-N-ethane Sulphonic acid)
• Antibiotics:Penicilin,Gentamicine,Polymyxin
• Storage period-96hrs.
K-Sol:
• Purified chondroitin sulphate in tissue culture medium (TC 199).
• Storage:7-10days in 40 C.

36. CONSTITUENTS DEXOL OPTISOL
Base medium MEM Hybride of Tc199 & MEM
Chondroitin Sulphate 1.35% 2.5%
Dextran 1% 1%
HEPES buffer Yes Yes
Gentamicine sulphate Yes Yes
Non essential amino acids 0.1mM 0.1mM
Sodium Bicarbonate Yes Yes
Sodium Pyruvate 1mM 1mM
Additional antioxidants Yes Yes
Other* No Yes
*ascorbic acid,Vit B12,ATP precursor

37. PRESERVATION OF CORNEA
• Long term Organ Culture storage system
 MEM media(minimum essential media)
 Developed by Hary Eagle.
 34 degree C
 Incubated at room temp in nutrient medium
 Storage perid : 30 days
 Advantage:enables HLA matching
• Very long time preservation:
 Cryopreservation
 1year
Constituents Concentration
Defined fetal bovine serum 10%
Chondroitin sulphate 1.35%
L-Glutamine 2mM
Sodium Pyruvate 1mM
Non essential Amino acids 0.1mM
2-mercaptoethanol 0.44mM
Gentamicin sulphate 100mg/ml

39. AGE FOR EYE DONATION
No influence of age on transplant outcome.
Older age : usage rate declines due to low endotheleal count
Lower limit : 2 yrs to prevent myopic shift after keratoplasty

40. INFORMATIONS
•It is only one phone
call away
•Call the nearest eye
bank or 1919 or 1053
or 104

42. Thank you