eye banking1
TRANSCRIPT
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