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