eye banking and corneal transplantation 10.03.16,dr.k.n.jha

Dr. K N Jha, MSProfessor of Ophthalmology

Email: kirtinath.jha@gmail.com

Eye Bank• An "Eye Bank" is a not for profit community

organisation governed by a Board of Directors or

Trustees constituted by community representatives.

It is the link between donor and recipient/eye surgeon.

It is an organization recognized by the government to

collect and distribute human eyes to those requiring

corneal transplantation.

StructureMedical section : Medical Director ( A

qualified Corneal Surgeon), Trained technicians

Administrative Section: Eye Donation Counsellor / Social Worker / Health Educator / Clerk

Functions of the Administrative SectionThe administrative section is responsible for

- Public awareness programmes

- Liaison with government, local voluntary

and other health care agencies

- Fund raising

Functions of the Medical Section

Medical section deals with the entire technical operation of the eye bank:

-Tissue harvesting, tissue evaluation, tissue

preservation, tissue distribution following

medical quality of highest standard.

Functions of the Eye BankNetworking of eye banks under the umbrella

of a national organisation( e.g. Eye Bank Association of India) allows

-Public education programmes

- Institution of newer eye banking procedures

- Training programmes and development of

uniform medical standards

Requirements• Communication facilities( telephone)

• Equipments such as slit lamp and laminar flow hood, surgical instruments, sterilisation facilities, serology laboratory, preservation media and appropriate transportation system.

• Round the clock coverage by fully trained technicians

• Nationwide network to facilitate optimal utilisation of all corneas.

Eye Banking StandardsDirectorate General of Health

Services( DGHS), Ministry of Health & Family

Welfare, Government of India has laid down

standards of Eye banking in India.

Pledge and ConsentFamily pledge for eye donation

Consent from the next of kin

Problems of Eye BankingInformation and accessibility

Medical issues/ contraindication

Climatic factors

Cultural and religious issues

RetrievalRetrieval by Medical officer or a trained

paramedic

The instruments

Methods: whole eyeball/ sclero-corneal button

Cornea ProcessingDisinfection

Slit lamp examination and classification

Processing under laminar airflow

Corneal StorageShort-term storage : MKK Medium

Intermediate term storage

Long-term storage

Distribution of CorneaDistribution to only hospitals and

ophthalmologists registered under HOTA

Maintenance of waiting list

Distribution record

Feedback from the hospital receiving cornea

Eye Bank Association of India( EBAI)EBAI is a not for profit society.

Any person / organization can become a member

A national organization acting as a resource

center.

Objectives : increase collection of eyes, introduce

uniform standards in eye banks and to educate

public about eye donation and prevention of

corneal blindness.

SummaryWhat is an Eye bank ?

Eye Donation: Pledge, consent, collection,

processing , and distribution

Human Organ Transplantation Act ( HOTA)

( Keratoplasty)

Corneal TransplantationCorneal transplantation refers to surgical

replacement of a full-thickness or lamellar portion

of the host cornea with that of a donor eye.

Allograft/autograft

Full-thickness( Penetrating)/ Partial thickness

( lamellar)

Corneal Transplantation :Schematic

Types of Keratoplasty

Optical – to improve vision

Tectonic- to restore or preserve corneal integrity

Therapeutic- to remove infected corneal tissue

Cosmetic- to improve appearance

Keratoplasty : Schematic Diagram

Indications of Penetrating Keratoplasty( PK)

Keratoconus

Post- cataract surgery edema

Corneal dystrophies and degenerations

Mechanical or chemical trauma

Microbial/postmicrobial keratitis

Congenital opacity

Corneal Opacity

Vascularised Corneal Opacity

Preoperative EvaluationSystemic evaluation

A complete eye examination

Examination of the ocular adnexa

Surgical TechniqueDetermination of graft size

Excision of donor cornea

Excision of diseases host cornea

Fixation of donor button

Removal of viscoelastic substance

Removal of Corneal Button

Corneal Transplant

Intraoperative ComplicationsDamage to the lens and/or iris

Irregular trephine

Poor graft centration

Excessive bleeding from the iris and wound edge

Choroidal hemorrhage

Iris incarceration in the wound

Damage to the donor endothelium

Postoperative CareTopical steroids and antibiotics

Mydriatic

Oral antiviral

Removal of suture

Rigid contact lens for residual astigmatism

Post operative ComplicationsInfection

Suture dehiscence

Corneal allograft rejection ( epithelial/ stromal/ endothelial)

Secondary glaucoma

Prognostic factorsAbnormalities of eyelid

Tear film function

Recurrent and progressive conjunctival

Inflammation

Stromal vascularisation

Uveitis and anterior synechia

Uncontrolled glaucoma

Lamellar keratoplastyLamellar keratoplasty refers to replacement of

only a portion of the corneal layers of the host cornea with the graft.

Indications:

-Opacification of superficial corneal stroma

-Marginal thinning or infiltration

-Localised thining / descematocele formation

Types of Lamellar KeratoplastySuperficial/ Deep anterior lamellar

keratoplasty ( SALK/DALK)

Descemet stripping automated endothelial keratoplasty (DSAEK)

Descemet membrane Endothelial Keratoplasty (DMEK)

Anterior Lamellar Keratoplasty

Triple ProcedureCataract extraction

Intraocular lens implantation

Corneal transplantation

FREQUENTLY ASKED QUESTIONS

What is an Eye Bank ?

What is meant by corneal transplantation?

How is the tissue harvested from a donor?

How quickly should the corneas/eyes be removed after death?

FREQUENTLY ASKED QUESTIONS Is it necessary to transport the donor to the

hospital after death for donating eyes?

How will the donated eyes be used?

Does the human body reject the transplanted donor cornea?

FREQUENTLY ASKED QUESTIONS What conditions render corneas unfit for

donations?

Do cataracts or the use of spectacles render the corneas unfit?

What about diabetes or hypertension?

FREQUENTLY ASKED QUESTIONS Does eye donation disfigure the donor’s face?

Is there any use of corneas that are for some reason not utilised for surgery?

Do religious authorities approve of donating one’s eyes?.

FREQUENTLY ASKED QUESTIONS

Will the donor or recipient family be told who donated or received the cornea?

Will the donor family be given fees?

Is there any delay in funeral arrangements?

Points to RememberDefinition of keratoplasty

Indications

Methods

Complications of keratoplasty

Prognosis of keratoplasty

Recent advances