EYE BANKING Dr. Smitha

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

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).

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.

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

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

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 .

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

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

Who can Donate? Any Body can Donate No Age Bar

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

Who can not Donate? AIDS Hepatitis B Rabbies Septicimia

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

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

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

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

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.

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

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

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.

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 -

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.

Enucleation Sclero corneal button PROCUREMENT Enucleation Sclero corneal button

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

What happens after eye donation .

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

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

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

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

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

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

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

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

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

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

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

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 0.025 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 .

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

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

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.

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.

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.

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.

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.

. THANK YOU