eye-banking.ppt

eye banking

1. Eye banking

2. ITISANONPROFITCOMMUNITY
ORGANIZATION WHICHDEALSWITH
THECOLLECTION ,STORAGE ,&
DISTRIBUTIONOFCORNEAFORTHE
PURPOSEOFCORNEAL GRAFTING,
RESEARCH &SUPPLY OFTHE
OTHEREYETISSUESFORTHEOTHER
PURPOSES

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

4. Serological Testing
Tissue Distribution
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
1.Donor selection
2.Tissue retrival
3.Corneal examination
4.Tissue transportation
5.Storage of corneal tissue
6.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. 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
2.corneal edema with associated haze
3.abnormal corneal shape
4.blood or cloudiness in the anterior chamber
5.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% chondroitinsulphate
to extend the corneoscleralstorage period
to up to 7 –10 days
Disadv: corneal swelling
•DEXOL AND OPTISOL :
oDEXTRAN TO K SOL
ostorage 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
1.100 ml of MEM(minimum essential
medium) medium
2.Earle’s salt solution
3.Antimicrobial agents
cultured bottle is closed & incubated in dry
and at 31 -37▫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
1.tissue harvesting, processing &
distribution
2.creating public awareness
3.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
1)EYE BANK INCHARGE:
2)EYE BANK TECHNICIAN
3)CLERK –CUM–STOREKEEPER
4)MEDICAL SOCIAL WORKER /
PUBLIC RELATION OFFICER
5)DRIVER -CUM -PROJECTIONIST

27. •1. General supplies
1.Donor information sheet, consent forms
2.Pen-light—for gross examination of eyes
3.container with water, ice and special foam to
transport the tissue
4.Supplies for blood collection
5.Non sterile gloves
6.Broad spectrum antibiotic solution
7.Eye protection (safety goggles), shoe covers
8.Disinfectant solution
9.Eye caps/prosthesis
10.Biohazard disposable bag
11.Gauze and cotton pads
Two small closed stainless containers for gauze pads
soaked in 70 percent alcohol in one and 5 percent
betadinein 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-4.6millions

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