1. Eye banking

2. 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

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

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

5. 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.

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

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

8. 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

9. 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.

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

11. 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

12. 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

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

14. CORNEAL EVALUATION

15. 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.

16. STORAGE METHODS

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

18. 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

19. 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

20. 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 ▫ C

21. Uses of Donated Eyes
Corneal Transplantation
Emergency Patching
Medical Education
Research

22. EYE BANK ORGANIZATION

23. 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.

24. 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.

25. 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.

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

27. 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.

28. 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.

29. 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.

30. 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

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

32. 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.