EYE BANKINGChairman: Prof. Md. Saifullah Head of dept. Cornea,NIO&H

Moderator: Dr. Farhat Jahan Jr.Consultant,Dept.of cornea, NIO&H

Presenter: Dr.Mst. Maskura Khatun DO Resident,NIO&H

Why eye banking?Global blindness & need of eye banking: The problem of blindness all over the world is as old as mankind itself .As estimated every 5 seconds –one individual goes blind in the world, is growing rapidly & is expected to be doubled by the year 2020

Cont.. Corneal blindness is much less in frequency than cataract.

The gravity of the problem is more serious mainly due to two reasons- 1 Over 50% of corneal blindness occurs in children, 2 The economic loss due to corneal blindness is much more than cataract blindness

Cont..*To combat the problem of corneal blindness in developing countries some specific steps have to be adopted all over •Establishment of good eye banking services •Excellent publicity for eye donation•Adequate facilities for tissue procurement

Cont..•Uniform and feasible law for eye donation

•Availability of improved storage media

•Training of medical personnel in eye enucleation

•More availability of trained corneal surgeons

History 1903: 1st successful corneal transplantation human to human performed by Zirm at Czechoslovakia.

1944: Dr. R. Townley Paton established the first eye bank “Sight Restoration”in New York City.

1961: Eye Bank Association of America was established

Cont..1973 Doughman with his team,organ culture method -cornea is stored up to 6 weeks.

1974: McKarey and Kaufman,M-K medium -4 days at 4°C.

1985: Kaufman presented K-Sol as a storage method viable for up to 10 days.

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 the tissue for other ophthalmic purposes

Objectives of an eye bankCollection of donor eyes

Process and storage of donor cornea

Distribution & utilization of the highest quality of donor tissue for transplantation

To promote public education relation system.

Cont..To promote Hospital Cornea Retrieval Programme to improve collection of donor eyes from hospital detail

Provide & process eye tissue for teaching or research

Steps of collection1. Donor selection

2. Tissue retrieval

3. Corneal examination

Donor selection Age of donor: no influence of age on

transplant outcome. Older age Lower limit : 2 yrs of age

Medical history review : Cause of death Medications Laboratory reports

General supplies

Donor information sheet, consent forms, etc Pen-light Insulated container with water ice to transport the tissue Supplies for blood collection Broad spectrum antibiotic solutionEye protection (safety goggles), shoe covers

Cont..Gauze and cotton pads. Sterile gloves, sterile double holed drapeDisinfectant solution Eye caps/prosthesis Two eye jars with eye cages . Eye jars should be labeled left and right. All instruments of enucleation procedure & For corneal excision (autoclaved)

Legal consent taken from next of kin

consented donor meets medical and social history screening criteria

physical assessment reveals no contraindication to donation

acquisition of donor tissue can be carried out.

Cont..

Donor eligibility blood test

HIV Hepatitis-B Hepatitis C Syphilis

Collection of postmortem blood:10ml Femoral vein/Subclavian vein/Heart/Jugular vein

TISSUE RETRIVAL

Corneo-scleral excision

Enucleation.

Tissue retrieval

Corneo-scleral excision

Tissue retrieval

Tissue retrievalContraindication: Systemic:Death from unknown causes

Congenital Rubella

Reye’s syndrome

Active bacterial or viral encephalitis

Cont… Active bacterial or viral endocarditis

Creutzfeldt-Jakob disease

Progressive multifocal leukoenchephalopathy

Leukemia ,Active disseminated Lymphoma

AIDS, Rabies etc

Cont..Contraindication: Ocular:• Intrinsic eye diseases Retinoblastoma Malignant tumor of ant. segment Active

conjunctivitis,iritis,uveitis,vitreitis,retinitis . • Prior refractive procedures (radial

keratotomy, lamellar inserts, LASIK)

Cont..Other factors to be considered-•Slit lamp appearance of donor tissue•Specular microscopy data-endothelial cell count <2000cells/mm2 are not used•Death to preservation time <12to 18 hours•Tissue storage time

CORNEAL EVALUATION

Corneal evaluationA simple penlight examination:

1. Epithelial defects (drying, erosion, sloughing

2. Corneal edema3. Abnormal corneal shape4. Blood or cloudiness in A/C.5. Corneal scars or infiltrates.6. Signs of conjunctivitis and discharge.

Cont..

The slit-lamp examination: Whole eyes can be examined within the

container used for the retrievalExcised cornea : from the bottom of the

storage vialCornea should be allowed to reach the

room temp.

STORAGE METHODS

Storage of donor tissue

Storage method

Short termUpto

96hoursMoist

chamber (24hrs),M

-K medium

IntermediateUpto 2weeks,

K-sol,Optisol,Optiso

l GS

Long term(Months to years)

Organ culture method,cryo-preservation

Preservation of corneaMoist chamber storageStorage of whole globe4◦C24 hours.

Cont…M-K medium:Described by Mc Caray & Kaufman.Storage period-96hrs.K-Sol: Purified chondroitin sulphate in tissue culture medium (TC 199).

Labeling of tissue Each corneal tissue shall be clearly labeled to include the following information.

Name of the source eye bankTissue identification numberType of tissueAge of donor

Cont..Cause of deathDate &time of donor’s death & enucleationDate &time of tissue preservationExpiration date for donor tissue

Distribution of tissueTissue shall be distributed to the ophthalmologists, institutions & other eye banks.Distribution is just equitable & fair to all patients without regard to recipient’s sex,age,religion,race,colour or national origin.

To make the society aware of the eye donation procedure

Public awareness meeting with various societies, schools etc.

Advertisement in Print media Advertisement in TV, Movie Banners, Posters, Leaflets Other campaigning methods like rally, skits

etc

Awareness

Birth of SNEDS

Dr Silva visited Bangladesh during November 23-25, 1984

SNEDS( Sandhani National Eye Donation Society) and Sandhani International Eye Bank was launched (Nov 25, 1984)

Sandhani's President (1984) is handing over Life Membership Certificate to Dr Hudson Silva

Dr Hudson Silva

In 1984, Sandhani’s Rangpur unit encountered an approach for cornea for an 18-year old adolescent girl

The girl, Tuntuni was blind from early childhood

Sandhani contacted Dr Hudson Silva from Sri Lanka for a pair of corneas for Tuntuni

Background…

EYE BANK ORGANIZATION

Organogram of Sandhani International Eye Bank

Eye Bank Management Committee

Central Executive CommitteeSandhani National Eye Donation Society

Eye Bank Medical Director Eye Bank Coordinator

Eye Donation Councilor Eye Bank Technician

Driver Messenger

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 is 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.

Eye banksMiddle tier is Eye Banks(EB )

These Eye Banks would be closely linked with Eye Donation Centers- EDC

EYE DONATION CENTERS

Publicity of the voluntary donation RegistrationArrangement for the collection of the eye

after deathProcessing , packing , & transportation of

collected eye to attached eye bank

Take home messageCorneal blindness is both a health and socio-economic problem.

Currently available curative treatment is surgery, by cornea transplantation.

Social and religious leaders, different media can create a mass movement of posthumous eye donation .

Cont..Fair and equitable distribution of transplantable tissues to corneal surgeons according. to waiting list.

Eye banking should no longer be an art but should be a precise science.

Don't Burn or Bury

Your Eyes.....

Donate Them!

Thank you all