1. EYE BANKING
Dr. Smitha

2. History
In rabbit corneal transplantation was done by FRANZ REISINGER In 1824
 First Corneal Transplantation in human was done by EDWARD ZIRM in 1906 On Mr. Alois Gloger.
Filatov(1935) – Father of Keratoplasty
1945 First eye bank established at RIO, Madras
1960 First successful corneal transplant Dr. R. P. Dhanda and Dr. Kalevar

3. Eye Bank Association of America was founded in 1961.
A similar organization was established in India at LVP, Hyderabad 4th January 1989, known as Eye Bank Association of India (EBAI).

4. What Is An Eye Bank?
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 eye tissue for other ophthalmic purposes.
It is a non-profit community based organization, managed by a Board of Directors, eye bank manager and technician with the objective of increasing the quantity and quality of eye tissue.

5. The Importance of Eye Donation
Cornea procurement rate-India 22,000/ year
In India The Number of Corneal Blind Person are 22 Lakhs
Every Year 75,000 to 1,00,000 –Corneal Requirment
2,77,000 donor eyes to perform 1lakh/year

6. Eye Donation ONE EYE DONATION CAN GIVE VISION TO TWO PERSON
ONLY TO THE CORNEAL BLIND PERSON

7. The cornea is the clear tissue covering the front of the eye
The cornea is the clear tissue covering the front of the eye. It is the main focusing element of the eye. Vision will be dramatically reduced if the cornea becomes cloudy from disease, injury or infection .

8. Corneal blindness is a disorder that results from the cornea becoming clouded, making a person blind. This condition can result from a variety of diseases,injury or infection

10. Reasons for Corneal Blindness
1. Infections- Bacterial & Viral
2. Accidents
3. Hereditary diseases

11. Who can Donate?
Any Body can Donate
No Age Bar

12. Male, Female
Spectacle Wearer also can Donate
Patients with Blood Pressure
Diabetic Patients
Patients with Asthma
Those who undergone surgery

13. Who can not Donate?
AIDS
Hepatitis B
Rabbies
Septicimia

14. Eye Bank Research Public Tissue Awareness Harvesting Distribution
Evaluation
Preservation
Public
Awareness
Research . .

15. Eye Bank Activities Collection of donor eyes
Process and storage of donor cornea
Distributing Corneas to Various Hospitals Training Technicians about Eye Banking Public Awareness programme

16. Organisation of Eye Bank
Structure : Medical & Administrative
Components of Eye Bank
1.Eye Information Centre.
2.Eye Collection Centre.
3.Eye Bank Proper.

17. Eye information center (EIC)
create awareness
also issues eye donation card to the pledger
handover the signed pledge forms to the eye bank
Medical Social Worker

18. Eye collection center (ECC)
Receives call for eye collection,
collects the eye,
informs the eye bank,
dispatch the eye tissue to the bank and
issues an appreciation letter to the deceased family.

19. Eye bank proper Permission from the Government is necessary Staffing
Equipment
Eye Donation fortnight is observed from 25th August to 8thSeptember
HCRP

20. LEGAL ASPECTS
Registered Medical practitioner to certify the death and procure the eyes
Procurement by unregistered & Unauthorized body is punishable
No sale or payment
Presumed consent LAW

21. Rules of Donation
·         Donor pledges that his eye can be removed after death for corneal grafting. Here also permission of next of Kin needed.
·            Can be donated by next of Kin if not pledged by donor
· Law forbids eye removal of living person for donation. Act No.42. Of 1994 Transplantation of human Organs act 1994.

22. Contraindications to procurement
Systemic
AIDS and HIV seropositivity
Rabies
Active hepatitis
Creutzfeldt-Jackob disease
Active septicemia
Subacute sclerosing pan encephalitis
Lymphoma
Death from unknown cause
Progressive multifocal leukoencephalopathy
Ocular
Retinoblastoma,
Active inflammatory eye disease
Keratoconus, keratoglobus
Central opacities
Pterygium
Prior refractive procedures- Radial keratotomy, Laser ablation, lamellar inserts.
Anterior segment surgical procedures -

23. Preliminary Steps Eyes to be removed within six hours.
Keep donor’s eyes closed, put a small piece of ice over the lid.
Keep head end raised by six inches.
Switch off fan.
Keep A.C. on
Keep death certificate ready.

24. Enucleation Sclero corneal button
PROCUREMENT
Enucleation
Sclero corneal button

25. Enucleation not to be done in presence of family members.
Antibiotic drops to be put into eyes and enucleation done under asceptic conditions.
Conjunctiva to be stitched.
Artificial eyes to be put into socket and lids stitched.
Eye to be removed one after another transferred to wide –mouthed collection bottle. Eyeball to be kept, cornea facing upward, over cotton roll moistened with antibiotic.
The bottle, sealed, put into a thermocol box with ice cube, transported to eye bank.
10 ml of Blood collected

26. What happens after eye donation.

27. Assessment of Donor Tissue
Slit lamp examination eyeball
Corneal button by specular microscope

28. Anterior chamber – any crystals.
Corneal epithelium
microcystic edema, epithelial defects
Corneal storma
opacities, infiltrates, edema, DM folds
Endothelium
Guttata, snail track marks (stress fractures of endothelium)
Anterior chamber – any crystals

29. Specular microscopy Edothelial cell density - < 1500cells/mm
Severe polymegathism or pleomarphism
Presence of cornea guttata
Abnormally shaped endothelial cells –fused cells
Abnormal single cell defects
Severe edema of endothelium
Presence of inflammatory cells on endothelium

30. GRADING OF TISSUE EXCELLENT Vacuolated cells No epithelial defect
POOR
Vacuolated cells
Severe stromal cloudiness
Marked folds (heavy, numerous, central)
Endothelium- marked defects, low cell density, central vacuolated cells
EXCELLENT
No epithelial defect
No arcus senilis
No folds in DM
Excellent endothelium – no defects

31. CORNEA GRADING EXCELLENT VERY GOOD GOOD FAIR
NSFS (NOT SUITABLE FOR SURGERY)

32. NSFS (Not Suitable For Surgery)
1. For Training Doctors
2. Research and Study
Diabetic Retinopathy
Genetics
Glaucoma
Congenital Cataract

33. MANDATORY SEROLOGICALTESTS
HIV
Hepatitis ‘B’
Hepatitis ‘C’
Syphilis
All surgical tissue shall be stored in quarantine until results are negative

34. Methods of corneal preservation
Short term – Moist chamber method
Intermediate term storage –
Mc Carey-Kaufaman medium, chondriotin sulphate enriched media
Long term
Organ culture
CRYO - Preservation

35. Moist chamber storage Whole globe in a sealed container 4 degree C
Advantages
Simple, minimum manipulation
Disadvantage – time limit only 48 hours

36. Ingredients of cornea preservation media
Dextran – helps to keep the cornea thin
Chondroitin sulfate –
acts as antoxidant,
helps to retain viability of endothelium
Electorlytes –
Buffer buffer system – Hepes buffer
Antibiotics – gentamycin
Non essential amino acids –
Antoxidants
Insulin

37. MK Medium Base medium-TC 199 5% Dextran Bicarbonate buffer
Penicilline and gentamycin (50-200mcg/ml)
Phenol red as PH indicator
Stored at 4 degrees for upto 4 days
Corneal button

38. Chondroitin Sulfate enriched media
K SOL
DEXOL
OPTISOL
(KSOL+DEXOL)
TC199
Minimal essential medium(MEM)
TC199+ MEM
2.5%chondroitin sulphate
1.35%chondroitin sulphate
Hepes buffer M
Hepes buffer
Gentamycin sulfate 100 mcg/ml
Gentamycin sufate 100 mcg /ml
Non essential a.a
Non essental a.a.
Sodium pyruvate 1m/mole
Sodium Pyruvate 1,/mole
Additional oxidants
1% Dextran
Sodium bicarbonate
Upto 7days at 4 deg
Upto 10 days
14 days .

39. Long term storage ORGAN CULTURE METHOD Upto 35 days
Earle’s salts without L- glutamine
L- glutamine
Decomplemented calf serum
1.5% chondroitin sulfate

40. Tissue frozen at controlled rate upto -80 deg C .
CRYOPRESERVATION
Corneal rim is passed through a series of solutions containing increasing concentration of dimethyl sulfoxide (DMSO) upto 7.5%
Tissue frozen at controlled rate upto -80 deg C
Stored indefinitely at -160 deg C
Not popular
Disadvantages
Expensive
Highly trained technical persons needed
Slight error can lead to tissue damage

41. CODE OF ETHICS FOR EYE BANKS.
CODE OF ETHICS FOR
EYE BANKS
No rivalry with other eye banks.
Free exchange of eye with other banks.
No eye to be enucleated during life.
Eye not to be bought or sold.
No discrimination during the distribution.
Donor identity not to be disclosed.
Proper wait list to be maintained.
Bank not to have commercial publicity.
Pledging and funding to be done in defined manner.

42. CODE FOR EYE SURGEONS Competence to perform corneal surgery.
Donor cornea not to be bought or sold.
Competence to perform corneal surgery.
Cornea to be obtained from recognized bank only
Donor identity not to be disclosed.
Should process all medical details of donor and cornea.

43. CODE FOR COLLECTING PERSONNEL.
CODE FOR COLLECTING PERSONNEL
Should be polite, courteous, and sympathetic with donor relatives.
Enucleation to be done in privacy.
Eye removal only by ophthalmologist or medical practitioner trained in enucleation .
Should be respectful to the deceased’s body.
Mutilation to the body to be avoided.
Relatives to be intimated about the artificial eyes.
Donated eyes to be collected even if unsuitable.
Legal consent form to be signed and obtained.

44. HCRP MoU Activities for awareness Grief councellor Advantages
availability of medical history
availability of tissue from younger individuals
reduction in time interval between death and corneal excision
cost effectiveness and
large number potential donors.

45. You can help by
Pledging your eyes and encouraging your family members to donate as well.
Being a member of the eye donation centre.
Calling the nearest eye bank immediately when a death occurs in the family.
Motivating friends and relatives of the deceased to donate eyes.
Monetary support to the patient or to the Eye bank.

46. .
THANK YOU