About eye banking

1. EYE BANKING
Chairman: Prof. Md. Saifullah
Head of dept. Cornea,NIO&H
Moderator: Dr. Farhat Jahan
Jr.Consultant,Dept.of cornea, NIO&H
Presenter: Dr.Mst. Maskura Khatun
DO Resident,NIO&H

2. Why eye banking?
Global blindness & need of eye
banking: The problem of blindness all
over the world is as old as mankind
itself .
As estimated every 5 seconds –one
individual goes blind in the world, is
growing rapidly & is expected to be
doubled by the year 2020

3. Cont..
 Corneal blindness is much less in frequency
than cataract.
The gravity of the problem is more serious
mainly due to two reasons-
1 Over 50% of corneal blindness occurs in
children,
2 The economic loss due to corneal blindness
is much more than cataract blindness

4. Cont..
*To combat the problem of corneal
blindness in developing countries
some specific steps have to be adopted
all over
•Establishment of good eye banking
services
•Excellent publicity for eye donation
•Adequate facilities for tissue
procurement

5. Cont..
•Uniform and feasible law for eye
donation
•Availability of improved storage media
•Training of medical personnel in eye
enucleation
•More availability of trained corneal
surgeons

6. History
1903: 1st successful corneal
transplantation human to human
performed by Zirm at Czechoslovakia.
1944: Dr. R. Townley Paton established
the first eye bank “Sight Restoration”in
New York City.
1961: Eye Bank Association of America
was established

7. Cont..
1973 Doughman with his team,organ culture
method -cornea is stored up to 6 weeks.
1974: McKarey and Kaufman,M-K medium -
4 days at 4°C.
 1985: Kaufman presented K-Sol as a
storage method viable for up to 10 days.

8. What is an Eye Bank ?

9. Eye bank is an organization which deals
with the collection, storage and
distribution of the cornea for the
purpose of corneal grafting ,research
and supply of the tissue for other
ophthalmic purposes

10. Objectives of an eye bank
Collection of donor eyes
Process and storage of donor cornea
Distribution & utilization of the highest
quality of donor tissue for transplantation
To promote public education relation
system.

11. Cont..
To promote Hospital Cornea Retrieval
Programme to improve collection of donor eyes
from hospital detail
Provide & process eye tissue for teaching or
research

12. Steps of collection
1. Donor selection
2. Tissue retrieval
3. Corneal examination

13. Donor selection
 Age of donor: no influence of age on
transplant outcome.
Older age
Lower limit : 2 yrs of age
 Medical history review :
Cause of death
Medications
Laboratory reports

14. General supplies
 Donor information sheet, consent forms, etc
 Pen-light
 Insulated container with water ice to
transport the tissue
 Supplies for blood collection
 Broad spectrum antibiotic solution
Eye protection (safety goggles), shoe covers

15. Cont..
Gauze and cotton pads.
Sterile gloves, sterile double holed drape
Disinfectant solution
 Eye caps/prosthesis
 Two eye jars with eye cages . Eye jars should be
labeled left and right.
All instruments of enucleation procedure & For
corneal excision (autoclaved)

16. Legal consent taken from next of kin
consented donor meets medical and social
history screening criteria
physical assessment reveals no
contraindication to donation
acquisition of donor tissue can be
carried out.
Cont..

17. Donor eligibility blood test
 HIV
 Hepatitis-B
 Hepatitis C
 Syphilis
Collection of postmortem
blood:10ml
Femoral vein/Subclavian
vein/Heart/Jugular vein

18. TISSUE RETRIVAL
 Corneo-scleral excision
 Enucleation.

19. Tissue retrieval
Corneo-scleral excision

20. Tissue retrieval

21. Tissue retrieval
Contraindication: Systemic:
Death from unknown causes
Congenital Rubella
Reye’s syndrome
Active bacterial or viral encephalitis

22. Cont…
 Active bacterial or viral endocarditis
 Creutzfeldt-Jakob disease
 Progressive multifocal leukoenchephalopathy
 Leukemia ,Active disseminated Lymphoma
 AIDS, Rabies etc

23. Cont..
Contraindication: Ocular:
• Intrinsic eye diseases
 Retinoblastoma
 Malignant tumor of ant. segment
 Active
conjunctivitis,iritis,uveitis,vitreitis,retinitis .
• Prior refractive procedures (radial
keratotomy, lamellar inserts, LASIK)

24. Cont..
Other factors to be considered-
•Slit lamp appearance of donor tissue
•Specular microscopy data-endothelial cell
count <2000cells/mm2 are not used
•Death to preservation time <12to 18 hours
•Tissue storage time

25. CORNEAL EVALUATION

26. Corneal evaluation
 A simple penlight examination:
1. Epithelial defects (drying, erosion,
sloughing
2. Corneal edema
3. Abnormal corneal shape
4. Blood or cloudiness in A/C.
5. Corneal scars or infiltrates.
6. Signs of conjunctivitis and discharge.

27. Cont..
The slit-lamp examination:
 Whole eyes can be examined within the
container used for the retrieval
 Excised cornea : from the bottom of the
storage vial
 Cornea should be allowed to reach the
room temp.

29. STORAGE METHODS

30. Storage of donor tissue
Storage method
Short
term
Upto
96hours
Moist
chamber
(24hrs),M
-K
medium
Intermediate
Upto 2weeks,
K-
sol,Optisol,Optiso
l GS
Long term
(Months to years)
Organ culture
method,cryo-
preservation

31. Preservation of cornea
Moist chamber storage
Storage of whole globe
4◦C
24 hours.

32. Cont…
M-K medium:
Described by Mc Caray & Kaufman.
Storage period-96hrs.
K-Sol:
Purified chondroitin sulphate in tissue
culture medium (TC 199).

33. Labeling of tissue
Each corneal tissue shall be clearly labeled to
include the following information.
Name of the source eye bank
Tissue identification number
Type of tissue
Age of donor

34. Cont..
Cause of death
Date &time of donor’s death & enucleation
Date &time of tissue preservation
Expiration date for donor tissue

35. Distribution of tissue
Tissue shall be distributed to the
ophthalmologists, institutions & other eye
banks.
Distribution is just equitable & fair to all
patients without regard to recipient’s
sex,age,religion,race,colour or national origin.

36.  To make the society aware of the eye
donation procedure
 Public awareness meeting with various
societies, schools etc.
 Advertisement in Print media
 Advertisement in TV, Movie
 Banners, Posters, Leaflets
 Other campaigning methods like rally, skits
etc
Awareness

37. Birth of SNEDS
 Dr Silva visited Bangladesh
during November 23-25, 1984
 SNEDS( Sandhani National Eye
Donation Society) and Sandhani
International Eye Bank was
launched (Nov 25, 1984)
Sandhani's President
(1984) is handing over
Life Membership
Certificate to Dr Hudson
Silva
Dr Hudson Silva

38.  In 1984, Sandhani’s Rangpur
unit encountered an approach
for cornea for an 18-year old
adolescent girl
 The girl, Tuntuni was blind from
early childhood
 Sandhani contacted Dr Hudson
Silva from Sri Lanka for a pair of
corneas for Tuntuni
Background…

39. EYE BANK ORGANIZATION

40. Organogram of Sandhani International Eye
Bank
Eye Bank Management Committee
Central Executive Committee
Sandhani National Eye Donation Society
Eye Bank Medical Director Eye Bank Coordinator
Eye Donation CouncilorEye Bank Technician
Driver Messenger

41. 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.

42. EBTC
 . The top tier is 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.

43. Eye banks
 Middle tier is Eye Banks(EB )
These Eye Banks would be closely linked
with Eye Donation Centers- EDC

44. EYE DONATION 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

45. Take home message
Corneal blindness is both a health and
socio-economic problem.
Currently available curative treatment is
surgery, by cornea transplantation.
Social and religious leaders, different
media can create a mass movement of
posthumous eye donation .

46. Cont..
Fair and equitable distribution of
transplantable tissues to corneal surgeons
according. to waiting list.
Eye banking should no longer be an art
but should be a precise science.

47. Don't Burn or Bury
Your Eyes.....
Donate Them!

48. Thank you all