Eye bank

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Eye banks recover, prepare and deliver donated eyes for cornea transplants and research. The first successful cornea transplant was performed in 1905 and the first eye bank was founded in 1944. Currently, in the United States, eye banks provide tissue for over 80,000 cornea transplants each year [1] to treat conditions such as keratoconus [2] and corneal scarring. In some cases, the white of the eye (sclera) is used to surgically repair recipient eyes. Unlike other organs and tissues, there is an adequate supply of corneas for transplants in the United States, and excess tissue is exported internationally, [3] where there are shortages in many countries, due to greater demand and a less-developed eye banking infrastructure.

Contents

History

In 1905, when Eduard Konrad Zirm, MD, performed the first successful full thickness corneal transplant, [4] a long line of corneal transplantation, research and techniques began. During its existence, Zirm’s eye bank, located in a rural area of Austria, treated over 47,000 patients.

Ramón Castroviejo, a Spanish ophthalmologist, was an influential figure in both European and American developments in corneal transplantation, particularly from the 1920s through the 1940s. During his research fellowship at the Mayo Clinic, he developed a double-bladed knife for square grafts and conducted research that culminated in the development of new keratoplasty techniques.[ citation needed ]

The 1940s not only brought improvements to corneal transplantation, but also an incentive to mainstream those procedures into eye banking. R. Townley Paton, a renowned American ophthalmologist had become affiliated with Manhattan Eye, Ear & Throat Hospital, where he began performing corneal transplants with privately-acquired tissue. After performing many corneal transplants, Paton came to the conclusion that a formal system of eye collection needed to be developed – thus, the eye bank was born. In 1944, Paton established the world’s first eye bank, the Eye-Bank for Sight Restoration, in New York. [5]

The establishment of the world’s first eye bank was only the beginning of the great steps taken to improve corneal transplantation and to increase eye banking’s influence in the transplantation community. In 1955, 27 ophthalmologists (representing 12 eye banks), met with four major medical groups under the auspices of the American Academy of Ophthalmology and Otolaryngology (AAO&O). During that meeting, a Committee on Eye-Banks was formed and Paton was named Chairman.[ citation needed ]

Between 1956 and 1960, the Committee met numerous times, discussing various challenges shared by eye-banks, such as methods for increasing eye donations, the need for central clearing houses and the urgent need for uniform legislation in the eye-bank field. In October 1961, the Committee of Eye-Banks formed the Association during an organizational meeting in Chicago and named it the Eye Bank Association of America (EBAA).

Recovery of eye tissue

"Recovery" refers to the retrieval of organs or tissues from a deceased organ donor. [6] Recovery is currently the preferred term; although "harvesting" and "procurement" have been used in the past, they are considered inappropriate, harsh, and potentially inaccurate. [7] [8]

When an organ/tissue donor dies, consent for donation is obtained either from a donor registry or from the donor's next of kin. A recovery technician is then dispatched to the hospital, funeral home, or medical examiner's office to recover the donor's eyes. The recovery occurs within hours of the death of the donor. [1] The entire eye, called the globe, may be surgically removed (enucleated), or only the cornea may be excised in-situ and placed in storage media. There is a wide variety of storage media used in eye banking. Commercial preparations as well as organ culture medium can preserve corneas. The eye tissue is then transported to the eye bank for examination and preparation.

Laboratory processing

A sample of the donor's blood is also collected to test for infectious diseases such as HIV, hepatitis B, hepatitis C, human cytomegalovirus, syphilis, and sometimes others. The blood type is also tested, although corneas do not receive any blood supply and type matching is not necessary for transplantation.

If the entire eye is enucleated during the original recovery, then the cornea and part of the sclera are removed and placed in a container with preservation medium, and the sclera is cleaned and then preserved in alcohol. The corneas are visually examined and evaluated underneath a slit-lamp, and the number of endothelial cells are counted underneath a specular microscope.

Regulations

The Eye Bank Association of America (EBAA) was established in 1961, and its members include eye banks that operate not only in the United States, but also in Canada, Europe, the Middle East, and Asia. [9] The EBAA has established comprehensive medical standards for eye banks, and the standardized the training and certification of eye bank technicians. [9] These interventions are considered major contributions to the current safety of eye transplantation. [10] The EBAA is the national accrediting agency for eye banks. Accreditation requires site visits at least once every three years by the EBAA to evaluate adherence to established standards and quality control. [11] The U.S. Food and Drug Administration (FDA) licenses eye banks, and conducts their own inspections, typically on a two-to-three year cycle.

To avoid violating the Health Insurance Portability and Accountability Act, eye banks must, through their legal anatomical authorizations, obtain consent which allows Eye Bank Association of America representatives access to donor information for accreditation reviews.

See also

Related Research Articles

Keratoconus Medical condition

Keratoconus (KC) is a disorder of the eye that results in progressive thinning of the cornea. This may result in blurry vision, double vision, nearsightedness, irregular astigmatism, and light sensitivity leading to poor quality-of-life. Usually both eyes are affected. In more severe cases a scarring or a circle may be seen within the cornea.

Cornea Transparent front layer of the eye

The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical power. In humans, the refractive power of the cornea is approximately 43 dioptres. The cornea can be reshaped by surgical procedures such as LASIK.

Eye surgery Surgery performed on the eye or its adnexa

Eye surgery, also known as ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist. The eye is a very fragile organ, and requires extreme care before, during, and after a surgical procedure to minimise or prevent further damage. An expert eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. Today it continues to be a widely practiced type of surgery, with various techniques having been developed for treating eye problems.

Corneal transplantation Surgical procedure of repairing corneal tissue to treat corneal blindness

Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue. When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Keratoplasty simply means surgery to the cornea. The graft is taken from a recently deceased individual with no known diseases or other factors that may affect the chance of survival of the donated tissue or the health of the recipient.

Eduard Zirm

Eduard Konrad Zirm was an Austrian ophthalmologist who performed the first successful human full-thickness corneal transplant on 7 December 1905.

Epikeratophakia is a refractive surgical procedure in which a lamella of a donor cornea is transplanted onto the anterior surface of the patient's cornea. A lamellar disc from a donor cornea is placed over the de-epithelialized host cornea and sutured into a prepared groove on the host cornea. Indications include treatment of keratoconus, refractive errors like myopia and high hypermetropia including aphakia, which cannot be corrected with conservative methods.

Keratoglobus is a degenerative non-inflammatory disorder of the eye in which structural changes within the cornea cause it to become extremely thin and change to a more globular shape than its normal gradual curve. It causes corneal thinning, primarily at the margins, resulting in a spherical, slightly enlarged eye.

Lions Eye Bank is the designation given to the various non-profit eye banks operated by member chapters within the Lions Clubs International service organisation. The banks store and prepare donated corneas for transplantation. Corneas may be stored for up to fourteen days before being distributed to an ophthalmic surgeon for transplantation.

Pellucid marginal degeneration Degenerative corneal condition

Pellucid marginal degeneration (PMD) is a degenerative corneal condition, often confused with keratoconus. It typically presents with painless vision loss affecting both eyes. Rarely, it may cause acute vision loss with severe pain due to perforation of the cornea. It is typically characterized by a clear, bilateral thinning (ectasia) in the inferior and peripheral region of the cornea, although some cases affect only one eye. The cause of the disease remains unclear.

Keratoprosthesis

Keratoprosthesis is a surgical procedure where a diseased cornea is replaced with an artificial cornea. Traditionally, keratoprosthesis is recommended after a person has had a failure of one or more donor corneal transplants. More recently, a less invasive, non-penetrating artificial cornea has been developed which can be used in more routine cases of corneal blindness. While conventional cornea transplant uses donor tissue for transplant, an artificial cornea is used in the Keratoprosthesis procedure. The surgery is performed to restore vision in patients suffering from severely damaged cornea due to congenital birth defects, infections, injuries and burns.

Peter S. Hersh is an American ophthalmologist and specialist in LASIK eye surgery, keratoconus, and diseases of the cornea. He co-authored the article in the journal Ophthalmology that presented the results of the study that led to the first approval by the U.S. Food and Drug Administration (FDA) of the excimer laser for the correction of nearsightedness in the United States. Hersh was also medical monitor of the study that led to approval of corneal collagen crosslinking for the treatment of keratoconus.

SightLife is an eye bank, a non-profit organization that obtains, medically evaluates and distributes corneas donated by individuals for use in corneal transplantation, research, and education. Since 2009 it has been the leading eye bank in the United States. SightLife provides volunteer services in India, Paraguay and Nepal.

Post-LASIK ectasia is a condition similar to keratoconus where the cornea starts to bulge forwards at a variable time after LASIK, PRK, or SMILE corneal laser eye surgery. However, the physiological processes of Post-Lasik ectasia seem to be different from Keratoconus. The visible changes in the basal epithelial cell and anterior and posterior keratocytes linked with keratoconus were not observed in post-LASIK ectasia.

Corneal ectatic disorders or corneal ectasia are a group of uncommon, noninflammatory, eye disorders characterised by bilateral thinning of the central, paracentral, or peripheral cornea.

The Legacy Devers Eye Institute in Portland, Oregon, is one of the few private, non-profit centers for ophthalmological care, research, and training in the United States. The institute is affiliated with Legacy Health, a network of seven hospitals in Portland and Southwest Washington. Legacy Devers includes the Thelma and Gilbert Schnitzer Comprehensive Glaucoma Center.

ProfessorKeryn Anne Williams is an Australian medical scientist who works in the field of ophthalmology. She was a Principal Research Fellow in the School of Medicine at Flinders University. Her research interests include clinical and experimetnal corneal transplantation, ocular inflammation, ocular immunology and eye banking.

Corneal button

A corneal button is a replacement cornea to be transplanted in the place of a damaged or diseased cornea normally approximately 8.5–9.0mm in diameter. It is used in a corneal transplantation procedure whereby the whole, or part, of a cornea is replaced. The donor tissue can now be held for days to even weeks of the donor's death and is normally a small, rounded shape. The main use of the corneal button is during procedures where the entirety of the cornea needs to be replaced, also known as penetrating keratoplasty.

Herbert Edward Kaufman is an American ophthalmologist who discovered idoxuridine, the first clinically useful antiviral agent; co-developed with William Bourne the clinical specular microscope to view the live corneal endothelium, co-developed timolol with Thomas Zimmerman, a new class of medications to treat glaucoma; corneal storage media for eye banks; natamycin, the first commercially available medication to treat fungal infections of the eye; co-developed with Tony Gasset the use of bandage contact lenses; and was involved in the first laser vision photorefractive keratectomy of the eye with Marguarite McDonald.

Anastasios John Kanellopoulos is a Greek-American eye surgeon specializing in corneal transplantation, cornea crosslinking for keratoconus, complicated cataract surgery and complicated glaucoma. Widely known for research and clinical contributions in micro-incision cataract, customized laser refractive surgery and corneal cross-linking propagation and most innovations, reducing corneal transplants for advanced keratoconus.

References

  1. 1 2 "Eye Banking Facts & Statistics". Eye Bank Association of America. Retrieved 2018-07-19.
  2. ↑ Romero-Jiménez, M.; Santodomingo-Rubido, J.; Wolffsohn, J. S. (2010). "Keratoconus: A review". Contact Lens and Anterior Eye. 33 (4): 157–166, quiz 166. doi:10.1016/j.clae.2010.04.006. PMID   20537579.
  3. ↑ "2009 Eye Banking Statistical Report" (PDF). Eye Bank Association of America. Archived from the original (PDF) on 2014-05-06. Retrieved 2013-01-23.
  4. ↑ Armitage, WJ; Tullo, AB; Larkin, DF (October 2006). "The first successful full-thickness corneal transplant: a commentary on Eduard Zirm's landmark paper of 1906". The British Journal of Ophthalmology. 90 (10): 1222–3. doi:10.1136/bjo.2006.101527. PMC   1857444 . PMID   16980643.
  5. ↑ Paton, D (1991). "The founder of the first eye bank: R. Townley Paton, MD". Refractive & Corneal Surgery. 7 (2): 190–4, discussion 194–5. doi:10.3928/1081-597X-19910301-17. PMID   2043567.
  6. ↑ Health Resources & Services Administration. "Terms and Topics - R". U.S. Department of Health and Human Services. Retrieved 2013-01-23.
  7. ↑ "Press Room". Michigan Organ Tissue and Donation Program. Gift of Life Michigan. Retrieved 2013-01-23.
  8. ↑ "Preferred Terminology". Lifebanc. Archived from the original on 2012-12-30. Retrieved 2013-01-23.
  9. 1 2 "Eye Bank Association of America, Inc. - EBAA". National Health Information Center. Archived from the original on 2012-10-10.
  10. ↑ Chu, W. (2000). "The past twenty-five years in eye banking". Cornea. 19 (5): 754–765. doi:10.1097/00003226-200009000-00020. PMID   11009327. S2CID   410116.
  11. ↑ "Eye Bank Association of America's Accreditation Status List" (PDF). EBAA. Retrieved 2013-01-23.


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