Eye Banking
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Transcript of Eye Banking
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Eye Banking
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Eye Bank
• A not -for –profit , community based organization, managed by a Board of Directors, with the objective of increasing the quantity and quality of eye tissue for human use and research purpose
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Eye Bank• 1935 – V.P. Filatov of Russia reported the
concept of cornea preservation and eye banking – FATHER OF EYE BANKING.
• 1944 – first eye bank established in NEW YORK by Dr. Townly paton.
• 1945 First eye bank established at RIO, Madras
• 1989 Eye Bank Association of India (EBAI) established
• 1999 Medical Standards of Eye Banking in India
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Magnitude of The Problem
• 1.3 million corneal blind in India• Mostly children and young adults• Current Collection - 22000 corneas• Current Requirement - 100,000 corneas Vast gap between demand and supply.
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Eye Bank
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EBAI – Eye Bank Association of India
• NGO• Voluntary organization• Based in Hyderabad• Charitable trust• Members – Ophthalmologists, Eye Bank
professionals, Philanthropists, NGOs
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EBAI services
• Setting up eye banks• Registration of eye banks• Capacity building• Implementation of standards• Creating awareness• Provide posters, literature, kits
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Eye bank - legal implications
• Transplantation of Human Organs Act(1994)• Consent is mandatory.• Required Request Law• Presumed Consent Law
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Eye Bank - Sources of Tissue
• Voluntary• Police mortuaries-Medico Legal Cases.• Hospital Cornea Retrieval Program(HCRP).• Other Eye Banks.
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EBTC
Eye bank
Eye Collection Centres
Eye BankingStructure in India
• Three Tiered
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Organization of eye bank
• Medical Director• Technical Director
• Co ordinator• Technician• Grief Counsellor
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Infrastructure
• Administrative Area• Laboratory Area – Tissue Processing Laboratory – Serology Laboratory – Instrumencleaning/Decontamination• Slit Lamp Biomicroscopy / Specular
Microscopy
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Eye Donation Centre
• Affiliated to a registered eye bank• Conducts public awareness programs• Coordinates between donor families & hospitals• Retrieves corneal tissue and blood for serology
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Eye Bank
• 24/7 Service• Public Education• Link between donor family & hospital• Retrieval, Evaluation, Processing of corneal tissue• Distribution• Safe transport• Documentation
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Eye Bank Training Centre
• All activities of an eye bank
• Training of eye bank personnel
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HCRP
• Proactive• Good Quality Tissue• Role of Grief Counselors• Public Awareness• Legal tie-up between the hospital and eye bank• Part of an organ donation program.
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HCRP• Success of HCRP - 3 factors1. Choice of hospitals2. Choice of counselors3. Regular monitoring of counselors
• Choice of Hospitals1. • Specialties2. • Mortality rate3. • Distance
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Contraindications• Tissue from donors with the following are potentially health
threatening and also affect the success of the surgery and shall not be offered for surgical purposes.
• Do not use for Keratoplasty
–Death from an unknown cause– Extensive burns– Septicemia– Death with CNS disease of unestablished diagnosis- Subacute sclerosing panencephalitis- Progressive multifocal leukoencephalopathy
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Contraindications• Active viral Hepatitis• Acquired immunodeficiency syndrome (AIDS) or HIV• Active viral encephalitis or encephalitis of unknownorigin• Creutzfeldt-Jakob disease• Rabies• Leukemias• Reye’s Syndrome• Active Tuberculosis
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Contraindications
• Instrinsic eye disease – Retinoblastoma – Malignant tumors of the anterior ocular
segment – Active inflammation at the time of death – Congenital or acquired disorders of the eye
that would preclude a successful outcome
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Contraindications• Laser photo ablation surgery .
• Corneas from patients with anterior segment surgery may be used if screened by specular microscopy and meet the Eye Bank’s endothelial standards.
• Laser surgical procedures such as argon laser trabeculoplasty, retinal and panretinal photocoagulaton do not necessarily preclude use for penetrating keratoplasty but should be cleared by the medical director.
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Donor to Host Transmission• Viral infections are the greatest hazard 1. Viruses with proven transmission - Rabies, C
– J Disease, Hepatitis2. Possible Transmission - HIV, HSV, CMV
Adenovirus, Epstein - Barr, Rubella virus 3. Transmission unlikely - V - Z virus• Other Factors1. Donor Age2.Death – Enucleation time
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Quality Practices
• At the donor site• Written consent from family
member • Two witnesses also to sign
consent form• Asepsis • Prepare a sterile field • Place sterile items
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• Prepare donor face and eyes• Donor blood screening • Collect 5ml blood • Determine Hemodilution status
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Corneo Scleral Button
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Eye Bank - Preservation Media
• Short Term (48hrs) - Moist Chamber• Intermediate Term (4 days) – McCarey - Kaufman medium K - Sol medium Dexsol medium• 7 days - Optisol medium• Long term storage - Organ Culture - Cryopreservation
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Moist chamber/Optisol Medium
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Donor Tissue Evaluation
• Gross examination• Slit Lamp Examination• Serological testing• Specular Microscopy
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Laminar Air Flow Hood
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Slit lamp evaluation
• Epithelium - intact/defects / exposure / infection• Stroma - clarity/cloudiness/arcus/opacities• Descemet’s membrane - folds/degree and location• Endothelium - excellent/very good / good / fair / Nsfs• Overall rating
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Tissue Preservation
• Corneal Preservation• Preservation of Sclera - Glycerine• Amniotic membrane - Dulbecco’s medium
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Konan Eye Bank Specular Microscope• Built - in high resolution CCD camera –
high quality image
• Built - in cell analysis system • XYZ / rocking platform mechanism – early
trackin of endothelial cells
• Built in pachymeter! corneas that have undergone refractive surgery
• Observe endothelium from a vial or corneal chamber
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• Morphology-Morphologically, endothelium is a singlelayer of hexagonal cells of uniform size.
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Donor Cornea Specular Microscopy
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• Parameters obtained by the cell analysis :1. Cell density (CD)2. Coefficient of variation of cell area (CV)3. Percentage of hexagonal cells (6A)
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Cell Density (CD)
• Inversion of cell area i.e. 1,000,000 divided by average cell area (1mm2 =1,000,000um2)
• Eg. Average cell area = 346 um2 then
• CD = 1,000,000/346 = 2890 cells /mm2
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Cell Densities• Excellent : cell density of >3000 cells/mm2
• Very good : cell density of 2500 – 3000 cells / mm2
• Good : cell density of 2000-2500 cells/mm2
• Fair : cell density of 1500-2000 cells/mm2
• Poor : cell density of 1200-1500 cells/mm2
• NSFS
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Coefficient of variation of cellarea (CV)
• Normal range : 0.20 – 0.30.
• Higher the CV (wide variety in cell sizes) higher polymegathism
• Lower the CV more stable the cornea
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Percentage of Hexagonal Cell (6A)
• Represents the shape factor of cells (Pleomorphism)
• Irregular cell shapes in traumatized endothelium elongation/triangle/octagon /square
• 6A is calculated as number of hexagonal cells/number of cells entered
• Higher the 6A – more stable the cornea
• >50% hexagonality is desirable
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Cornea evaluation criteria• Excellent: - no epithelial defect - crystal clear stroma - no flods in descemets membrane - excellent endothelium
. Very good: - slight epithelial haze - clear stroma - very slight arcus - few light folds - excellent endothelium
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Cornea evaluation criteria• Good :• - moderate epithelial defects• - light to moderate cloudiness• - moerate arcus senelis < 2.5 mm• - obvious folds• - few vacuolated cells• Fair :• - epithelial defects >6o %• - Moderate to heavy stromal clodiness• - heavy folds • - hevy arcus senelis • - fair to good endothelium
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Cornea evaluation criteria
• POOR• - moderate vacuolated cells• - severe stromal cloudiness• - marked folds• - fair endothelium – low cell density, marked
defects
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Donor Tissue
• Keratoplasty - Penetrating/Lamellar• Optical/Therapeutic/Tectonic• Research• Surgical training