BANK MATA

BAGIAN I.P. MATA

FAKULTAS KEDOKTERAN
UNIVERSITAS 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 non sterile 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.
b.
c.
d.
e.
f.
g.

Subacute sclerosing panencephalitis

Progressive multifocal leukoencephalopathy
Reyes syndrome
Death from unknown cause including unknown encephalitis
Congenital rubella
Active septicemia including endocarditis
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 endotheliumno
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