Eye banking

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

Functions of an Eye Bank : Promotion Registration Tissue Retrieval Tissue Processing Tissue Evaluation

Tissue Distribution Serological Testing RESEARCH ACTIVITIES: IMPROVEMENT IN PRESERVATION METHODOLOGY CORNEAL SUBSTITUTE UTILIZATION OF THE OTHER COMPONENTS OF THE EYE

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 according to waiting list.

STEPS OF EYE DONATION Donor selection Tissue retrival Corneal examination Tissue transportation Storage of corneal tissue Distribution

DONOR SELECTION A. AGE OF DONOR: Age above 70 is mostly avoided Cornea of infants and childrens are also not used for keratoplasty

B. 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

C. Legal consent should taken if consented donor meets medical and social history screening criteria physical assessment reveals no contraindication to donation acquisition of donor tissue can be carried out.

D. Serology testing E. Preparation of the donor povidone iodine 1- 5 % for 1-2 min + good stream of balanced saline

CONTRAINDICATION FOR THE USE OF DONOR TISSUE FOR KERATOPLASTY 1. Death of unknown cause 2. Death from central nervous system disease of unestablished diagnosis 3. Creutzfelt-Jacob disease 4. Subacute sclerosing panencephalitis 5. Progressive multifocal leukoencephalopathy 6. Congenital rubella 7. Reyes syndrome

8. Active encephalitis and septicemia 9 8. Active encephalitis and septicemia 9. Active bacterial or fungal endocarditis 10. Active viral hepatitis, Rabies 11. Active leukemias and Active lymphomas 12. High risk for or HIV infection 13. Hepatitis B and C 14. Retinoblastoma, malignant tumors of the eyes and Active ocular inflammation 15. Congenital or acquired disorders of the eye 16. Prior intraocular surgery or anterior segment surgery

TISSUE RETRIVAL enucleation i.e. surgical by in -situ removal of the whole eye corneo-scleral excision (globe is retained In the orbit)

CORNEAL EVALUATION

Corneal evaluation Examination of the corneas in situ A simple penlight examination and slit lamp microscopy: 1. epithelial defects (drying, erosion, sloughing corneal edema with associated haze abnormal corneal shape blood or cloudiness in the anterior chamber corneal scars or infiltrates, and any signs of conjunctivitis and discharge.

STORAGE METHODS

Moist chamber storage Sealed chamber with saline & antimicrobial solution Placed at 4▫ C Disadv: corneal stromal edema & limited storage period ( up to 24 hrs)

Hypothermic corneal storage Mc carey and kaufman medium - M K MEDIUM Added dextran as an osmotic solution Viability: 2-3 days M – K FORMULATION : add HEPES as buffer & gentamicin Viability period : 4 days

K SOLUTION : M – K FORMULATION + 2.5% chondroitin sulphate to extend the corneoscleral storage period to up to 7 – 10 days Disadv: corneal swelling DEXOL AND OPTISOL : DEXTRAN TO K SOL storage period max up to 14 days

Normothermic storage system Organ culture Incubated at room temp in nutrient medium Storage period : 30 days Glass bottle containing 100 ml of MEM(minimum essential medium) medium Earle’s salt solution Antimicrobial agents cultured bottle is closed & incubated in dry and at 31 - 37▫ C

Uses of Donated Eyes Corneal Transplantation Emergency Patching Medical Education Research

EYE BANK ORGANIZATION

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 . The top tier comprises of 5 Eye banking training centers (EBTC) responsible for tissue harvesting, processing & distribution creating public awareness training and skill up-gradation of eye banking personnel.

Eye banks Middle tier would comprise of a strong network of 45 Eye Banks(EB) These Eye Banks would be closely linked with 2,000 Eye Donation Centers- EDC (ratio of 1: 50 suggested), each of which would cater to a population ranging from 50,000 to 100,000.

EYE BANK PERSONNEL EYE BANK INCHARGE: EYE BANK TECHNICIAN CLERK – CUM– STOREKEEPER MEDICAL SOCIAL WORKER / PUBLIC RELATION OFFICER DRIVER -CUM - PROJECTIONIST

1. General supplies Donor information sheet, consent forms Pen-light—for gross examination of eyes container with water, ice and special foam to transport the tissue Supplies for blood collection Non sterile gloves Broad spectrum antibiotic solution Eye protection (safety goggles), shoe covers Disinfectant solution Eye caps/prosthesis Biohazard disposable bag Gauze and cotton pads Two small closed stainless containers for gauze pads soaked in 70 percent alcohol in one and 5 percent betadine in the other.

2. Autoclaved and sterile materials: a. A double holed drape b. Protective biohazard apparel-surgical gown (preferably moisture impermeable) cap, mask, etc. c. Cotton tipped applicators or hemostats to open the eyes. d. Sterile balanced salt solution or 0.9 percent sterile saline to irrigate the eyes e. Sterile gloves f. 8–10 pieces of gauze.

3. All instruments of enucleation procedure & For corneal excision (autoclaved) Blood samples are taken from the donor that is serologically tested for human immunodeficiency virus, Hepatitis B and Hepatitis C virus.

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

Blind Population World - About 40 millions India - more than 15 millions Corneally Blind - 4.6 millions

LEGAL ASPECTS IN INDIA Under the Transplantation of Human Organs Act, 1994 (THOA) The qualification of doctors permitted to perform enucleation (surgical eye removal) has been reduced from MS (Ophth.) to MBBS. Eye donation in India is always decided by the donor’s surviving relatives and not by the actual donor, Enucleating doctors always have to legally obtain a written consent from the relatives of the deceased before they actually remove the eyes.