Bank Mata

Fak kedokteran universitar wijaya kusuma surabaya

Eye banks are conceived to provide for:

procurement, processing, and distribution of
safe quality donor eyes
therapeutic use and research.1
Eye banks undertake comprehensive work
including promotional public relation activities
and
enhancement of public awareness, tissue
harvesting,
tissue evaluation, tissue preservation, and tissue
distribution.

Operational

Efficiency
Eye banking demands a very efficient
round-the-clock
operational system in receiving a donor
call and
executing a response for eye collection to
that call
preferably within 20-30 minutes

Equipment

for an eye bank

Mandatory Desirable
Refrigerator with temperature
recording device
Biological safety cabinet or
Slit lamp
Sterilization facilities
Enucleation and corneal
excision instruments

TISSUE

RETRIEVAL
Tissue can be retrieved for transplantation
either by
an enucleation,
an in situ corneoscleral excision

Preliminary

Procedures :
legal permission
the donors medical records
check for the ocular and medical
contraindications
Wash hands with alcohol or similar disinfectant
Put on protective clothingsurgical gown,
cap, mask, eye protection and nonsterile or
prep
gloves.
Identify the donor either by a toe tag or some
other form of identification label on the body of
the
donor

I.

Systemic
1. Conditions potentially hazardous to eye
bank
personnel and fatal, if transmitted:
a. Acquired immunodeficiency syndrome
or
HIV seropositivity
b. Rabies
c. Active viral hepatitis
d. Creutzfeldt-Jakob disease.

2.

Other contraindications:
a. Subacute sclerosing panencephalitis
b. Progressive multifocal leukoencephalopathy
c. Reyes syndrome
d. Death from unknown cause including unknown
encephalitis
e. Congenital rubella
f. Active septicemia including endocarditis
g. Acquired immunodeficiency high risk
behavioral features including homosexuals,
intravenous drug abusers, prostitutes and
hemophilics
h. Leukemia (blast form)
i. Lymphoma and lymphosarcoma

II.

Ocular
a. Intrinsic eye diseaseretinoblastoma,
active
inflammatory disease
(conjunctivitis, iritis,
uveitis,vitreitis,
retinitis), congenital
abnormalities
(keratoconus, keratoglobus), central
opacities and pterygium.
b. Prior refractive proceduresradial
keratotomy scars, lamellar inserts, laser
photoablation.
c. Anterior segment surgical procedures
(cataract,
glaucoma).

Preparation
Prepare

the donor as per operating room standards.

Open the right eye with the help of a sterile cotton
tipped applicator or sterile hemostat and copiously
irrigate the conjunctiva sac with sterile saline. Repeat
the same procedure on the left eye using a new
cotton
tipped applicator or hemostat. After irrigation, clean
both sides of orbital area with alcohol swab/alcohol
gauze held in a sterile hemostat. Make sure alcohol
does not enter the eyes.

32.1A to F: Donor eye enucleation

procedure. Following
360 degree peritomy (A), ocular muscles are cut
(B), eyeball is
then lifted (C), and optic nerve (D), as well as
oblique muscles
are cut (E). Finally, harvested eyeball is placed
in a glass vial
(F)

Corneoscleral button excision procedure. Scleral

incision 4-5 mm in length at 2-3 mm behind limbus
(A) is made, scleral incision is extended for 360
degrees (B), iris is pulled away from the cornea (C,
D)

Donor Cornea Viability

Evaluation Methods
Gross

Ex
A. Adnexa Dacryocystitis, styes, pustules,
discharge (conjunctivitis)
B. Cornea Epithelium edema, exposure, trauma
and foreign bodies. Stroma Arcus senilis, corneal
scarscentral/limbal (evidence of prior surgery),
corneal infiltrates, abnormal corneal shape/size,
e.g. keratoconus, edema.
Endothelium Keratic precipitates, central guttata
C. Anterior chamber Shallow/flat, blood in
anterior chamber, abnormal anatomy
congenital and acquired due to prior intraocular
surgery. amination

Cornea

viability rating scale2,4,5

Parameter Not present 1 2 3 4
Clarity crystal clear slight haze moderate haze heavy haze
Epithelial defects none not in center 50-90% of center > 90%
Epithelial edema none slight overall moderate marked
Scars 0 none peripheral peripheral central
Foreign bodies none none peripheral central
Stromal edema nonapparent slight peripheral mild entire thick
Opaque infiltrate 0 none none none none
Keratic none peripheral few central dense
precipitates
Arcus senilis none light, >8 mm >6 mm clear < 6 mm clear
clear cornea
Folds none peripheral central central
Guttata none 3-4 spots >4, central > 4, central
Jaundice 0 none light yellow moderate yellow orange
Endothelial count 2500/mm2 2000/mm2

Cornea

with specular endothelial patterns

unfit for transplantation
1. An endothelial cell density less than 1500
cells/mm2
2. Severe polymegathism or pleomorphism of
the
endothelial cells
3. Presence of central cornea guttata
4. Abnormally shaped cells such as fused cells
(these cells are seen in stressed endothelium)
5. Abnormal single cell defects
6. Severe edema of endothelium
7. Presence of inflammatory cells or bacteria
on endothelium

Final

cornea evaluation criteria

Excellent = rating 1 a. no epithelial
defects
b. crystal clear stroma
c. no arcus senilis
d. no folds in Descemets membrane
e. excellent endotheliumno defects.

Very

good = rating 2
a. slight epithelial haze or defects
b. clear stroma
c. very slight arcus
d. few light folds
e. very good to excellent endothelium
no defects.

Good

= rating 3 a. obvious moderate

epithelial defects
b. light-to-moderate cloudiness
c. moderate arcus senilis < 2.5 mm
d. obvious folds (numerous but shallow)
e. few vacuolated cells.

Fair

= rating 4
a. obvious epithelial defects (>60%)
b. moderate-to-heavy stromal cloudiness
c. heavy folds (numerous, deep, central)
d. heavy arcus senilis >2.5 mm
e. fair-to-good endotheliummoderate
endothelial defects, vacuolated cells,
low cell density.

Poor
a.

moderate vacuolated cells (some

central)
b. severe stromal cloudiness
c. marked folds (heavy, numerous,central)
d. fair endotheliummarked defects, low
cell density, numerous central vacuolated
cells
e. technical problems in removal.

Terima kasih