eye banking and vision 2020 - himsr.co.in · eye banking and vision 2020. about 285 million people...
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EYE BANKING and VISION 2020
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About 285 million people are visually impaired
worldwide: 39 million are blind and 246 million have low
vision (severe or moderate visual impairment)
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Preventable cause are as high as 80% of the total global visual impairment burden
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15 Million Corneal Blind In India,
out of which majority are Children.
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6.8 million of these 15 million suffer from
corneal blindness with vision less than 6/60 and of these about 1 million
have bilateral corneal blindness.
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If the present trend continues, it is expected
that the number of corneally blind individuals in India will increase to 10.6 million by 2020.
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Of these, 3million can be benefitted by keratoplasty.
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Top causes of visual impairment: refractive
errors, cataracts and glaucoma
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Top causes of blindness: cataracts, glaucoma
and age-related macular degeneration
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Cornea is the transparent, dome-shaped
window covering the front of the eye. It is a
powerful refracting surface, providing 2 / 3
of the eye's focusing power. Like the crystal
on a watch, it gives us a clear window to
look through.
Because there are no blood vessels in the
cornea, it is normally clear and has a shiny
surface. The cornea is extremely sensitive -
there are more nerve endings in the cornea
than anywhere else in the body.
The adult cornea is only about 1/2 MM thick
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CORNEAL TRANSPLANTAION ACT
HUMAN ORGAN TRANSPLATION ACT
THE TRANSPLANTATION OF HUMAN ORGANS ACT 1994
(11-7-1994)-
Central Act.
Adopted by the State Government in 1996.
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An act for regulation of
Removal ,storage & transplantation of human organs for therapeutic purposes
Prevention of commercial dealings in human organs
THE TRANSPLATION HUMAN ORGAN
ACT,1994
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Removal to be done by a Doctor only
Eye balls can be collected only after death is certified.
Consent to be given by next of kin
Hospital must be registered to conduct Transplantation
AUTHORITY FOR THE REMOVAL OF
EYES
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Eye banks are conceived to provide safe quality donor eyes for therapeutic use & research.
Eye Banks work as a Autonomous bodies
Eyebanks are either Govt. or NGO
Attached to a eye hospital or independent
Rules applied are of organ transplantation
Introduction
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1961- Ist Eye Bank in America
1964 - Ist Eye Bank in India
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In spite of the continued efforts of NPCB, only 250 Eye banks functional of the total 750 Eye banks established in India.
Only 7 functional eyebanks in Delhi
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WHAT IS AN EYE BANK
* Collection of Donor Eyes
* Evaluation of Corneas
* Distribution
* Educating the community
* Non-profit Organization
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1Eye Bank =20 million pop.1Eye Bank=40 Eye donation Center
EBTC=Eyebank& Training Center
EBC=Eye Donation CenterEB=Eye Bank
EFFECTIVE EYE BANKING
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EYE BANKS(EB) Vs EYE DONATION CENTER(EDC)
EB Independent Layout
Serology Equipment
Slitlamp biomicroscopy
Specular microscopy
Autoclaving unit
Lab. Refrigerator
Laminar Air flow hood
Complete staffing
Van & driver
MD,Manager,Technical staff,ED counselor,Secretory
EDC
Trained doctor for eye collection.
Enucleation set
Attached to a hospital for autoclaving facility
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TOTAL MORTALITY REPORTED PER DAY : AVERAGE 20-25
TOTAL MORTALITY IN 2015 : 6894 TILL DEC 1
TOTAL INCIDENCES OF RTA MORTALITY PER DAY : 5-8
TOTAL NUMBER OF SUCCESSFUL KERATOPLASTIES : 62 (2014)
V.M.M.C & SAFDARJUNG HOSPITAL
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Mass Publicity-Tv,Print,Electronic,Lectures
Voluntary Eye donatation-Older age
Grief Counseling
HCRP(hospital cornea retrival program)
Young corneas,more utilization,immediately after death
STRATEGIES FOR INCREASE EYE COLLECTION
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Either enucleation or in-situ corneal excision Eye collection with in 6-8hrs Preliminery procedure check donor medical
records.check for contraindications Strict aseptic precautions to be taken Collect blood(10ml) from the Jugular vein or
subclavian vein or heart. Transport media used is Thermocole box with Ice
Pack .mosit chamber or MK media.Temp at + 4deg C
RETRIVAL OF EYES
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AIDS
Leukemia
Hepatitis - A,B,C
Rabies
Encephalitis
Creutzfeldt-Jacob Disease
Septicemia
Unknown cause of death
ABSOLUTE CONTRAINDICATIONS FOR EYE DONATION
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WORK AT EYE BANK ON RECEIVING DONOR EYE
Donor Eye Evaluation
Slit lamp Bio-microscopy Examination
Specular Microscopy
Serology Test (Blood Test)
Fit for use Used for Research
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.
Moist chamber 48hrs Whole globe Glass bottle with moist cotton
McCarey-Kauffman Medium(MK Medium)
72 hours Corneal scleral button
Dextran & antibiotics
Optisol
Optisol GS
15 days Corneal scleral button
Tissue media 2-3wks Corneal scleral button
Dextran,chondrotinsulphate,electrolytes ,antibiotics,Essential aminoacids,insulin,epidermal growth factors,antiproteases,anticollagenase
Organ culture 35days Corneal scleral button
34 deg C
2-3days in special organ culture media at 34deg C in co2 5% water jacketed incubator
NO DEXTRAN & ANTIBOTICS.CLOSED MEDIA
2days later 130ml of media at 34 degC
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1964
18months
Tissue strored in Liquid nitrogen at --197deg C
At the time of thawing the cial containing cornea is placed in water bath at temp of 60dec C at 1min.
Trained techiques for Freezing & thawing
Cryopreservation
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GRADING OF DONOR EYE
EXCELLENT CORNEA(A) Crystal clear cornea ,no epithelial defect, Clear granular stroma &/or light arcus,no
striae,no endothelial defect
VERY GOOD(B) Slight epithelial haze &/or defect (central & or/Peripheral),clear stroma ,&/or slight
arcus,Few Shallow folds(striae),No guttata
GOOD © Obvious epithelial defects &/or light to moderate corneal cloudiness &/or
Moderate arcus<2.5mm,Obvious shallow striae, few guttata
FAIR Obvious epithelial defects &/or heavy stromal cloudiness &/or heavy numerous deep folds (
striae) & /or heavy arcus senilis>2.5mm,moderate guttate
NOT SUITABLE FOR SURGERY Cornea with heavy cloudiness or opacities & /or marked striae &/or marked
guttata&/or technical problems in removal&or/unable to collect donor blood for serology /poor maintance of cold chain/donor disease
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SPECULAR MICROSCOPY
Number of Endothelial cells
Polymegathism-variation in size
Pleomorphism-variation in shape
Index of endothelial function
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ENDOTHELIUM COUNT IN DONOR EYE
3000cell/mm2- Excellent
2500-3000cell/mm2 –Vgood
2000-2500cell/mm2-Good
1500-2000cell/mm2-Fair
<1500/mm-Not suitable for Optical surgery
USE IF MORE THEM 2000CELLS/MM2
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Maintance & caliberation of instruments (fridge,Laminar airflow,specular microscope)
Sterility check-Taking cultures in EB
Waste disposal
Yellow-Tissue waste,
Red-gloves,disposable,syringes,swabs,saline
Black-Paper,stationary
Infection safety control
Follow EBAI medical standards manual
EYE BANK STANDARDS
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Corneal reflex stimulationIce on donor eyes
Donor maintenance:
Closed eyes, humidification (no ice / ointments / gauges)
Short post mortem interval
Corneal reflex stimulation: gauge, sterile physiologic
Low ambient remperature
Corneal recovery
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Corneal recovery
Consent, ascertainment of
death, identification
Physical and in situ
inspection
Disinfection of peri-ocular
tissues, sterile field
preparation
Disinfection and rinsing of
ocular tissues
Excision/enucleation
Reconstruction
Medical-legal
requirements
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Dressing
Personal Protective
Equipment
Surgical scrub
Always work on a
clean and tidy work
surface
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Physical inspection of the donor (checking for evidence of
parenteral drug use, and other high-risk behaviors for AIDS and hepatitis)
Put on personal protective clothing
A visual head-to-toe inspection of each eye donor
should be performed, including the webs of fingers
and toes, as well as the groin and behind the knees
Look for:
bruises
lacerations, scars, piercing
needle tracks not compatible with recent pathological
anamnesis
fresh tattoos that may hide parenteral drug use, and other
high-risk behaviors
and signs of transmissable diseases such as Kaposi
sarcoma, swollen lymph nodes, skin rashes
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100% disposable material
100% traceability
Procurement: recovery cases
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Disinfection, rinsing, draping
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Peritomy, sclerotomy
Sclerotomy and recovery: instruments different from those for conjunctiva
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Sclerotomy
Scleral rim ~ 4 mm
Regular cutting
NO!
NO!
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Corneal-scleral rim detachment (most frequently
associated to technical errors)
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NO!
No instruments in the AC
No tension, distorsion
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Reconstruction
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Partners Partners
Collaborations for Management systems
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What is VISION 2020?
A Global Initiative to Eliminate
Avoidable Blindness
AIM:
“To intensify and accelerate present
prevention of blindness activities so as
to achieve the goal of eliminating
avoidable blindness by the year 2020”
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VISION 2020: The Right to Sight
is about
PARTNERSHIP
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IAPBWHO
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Global Blindness Projections
0
10
20
30
40
50
60
70
80
1975 1984 1990 2000 2010 2020
The number of blind people was increasing by at least 1 million / yr.
2838
76
50
Increasing population Increasing proportion of people aged 50 years +
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-
20
40
60
80
100 m people
Blindness Projections: With and Without Global Initiative
2000 2010 2020
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International Structure of VISION 2020
WHOVISION
2020
Professionals
Local NGOs
Int. NGOs
NATIONAL
VISION 2020
GROUPS
IAPB
Ministries
of
Health
DISTRICT VISION 2020 SERVICE UNITS
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Global Burden of Blindness andvisual impairment
Update in 2004, based on 2002 population Based on 55 new surveys
0
10
20
30
40
50
60
70
1990 1992 1994 1996 1998 2000 2002 2004 2006
37 Mo Blind
124 Mo Low
Vision
161 Mo V.
Impaired
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Reaching out to REAL Indian
population