Eye banks recover, prepare and deliver donated

eyes Eyes are organs of the visual system. They provide living organisms with vision, the ability to receive and process visual detail, as well as enabling several photo response functions that are independent of vision. Eyes detect light and conve ...

for

cornea transplant 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 ...

s 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 to treat conditions such as keratoconus and

cornea 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 ...

scarring A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...

. In some cases, the white of the eye (

sclera The sclera, also known as the white of the eye or, in older literature, as the tunica albuginea oculi, is the opaque, fibrous, protective, outer layer of the human eye containing mainly collagen and some crucial elastic fiber. In humans, and som ...

) 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, where there are shortages in many countries, due to greater demand and a less-developed eye banking infrastructure.

History

In 1905, when Eduard Konrad Zirm, MD, performed the first successful full thickness corneal transplant, 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 Ramón Castroviejo Briones (1904–1987) was a Spanish and American eye surgeon remembered for his achievements in corneal transplantation. Biography Born in Logroño, Spain he received his medical education at the University of Madrid. He grad ...

, a Spanish

ophthalmologist Ophthalmology ( ) is a surgery, surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Followin ...

, 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 The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...

, he developed a double-bladed knife for square grafts and conducted research that culminated in the development of new keratoplasty techniques. 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. 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. 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. Recovery is currently the preferred term; although "harvesting" and "procurement" have been used in the past, they are considered inappropriate, harsh, and potentially inaccurate. 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 A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...

funeral home A funeral home, funeral parlor or mortuary, is a business that provides burial and funeral services for the dead and their families. These services may include a prepared wake and funeral, and the provision of a chapel for the funeral. Services ...

, or

medical examiner The medical examiner is an appointed official in some American jurisdictions who is trained in pathology that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictio ...

's office to recover the donor's eyes. The recovery occurs within hours of the death of the donor. 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 The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...

hepatitis B Hepatitis B is an infectious disease caused by the ''Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. Fo ...

hepatitis C Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, a ...

human cytomegalovirus ''Human betaherpesvirus 5'', also called human cytomegalovirus (HCMV), is species of virus in the genus '' Cytomegalovirus'', which in turn is a member of the viral family known as ''Herpesviridae'' or herpesviruses. It is also commonly calle ...

syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...

, and sometimes others. The

blood type A blood type (also known as a blood group) is a classification of blood, based on the presence and absence of antibodies and inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrate ...

is also tested, although corneas do not receive any

blood supply The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...

and type matching is not necessary for transplantation. If the entire eye is enucleated during the original recovery, then the

and part of the

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 A slit lamp is an instrument consisting of a high-intensity light source that can be focused to shine a thin sheet of light into the eye. It is used in conjunction with a biomicroscope. The lamp facilitates an examination of the anterior segm ...

, and the number of

endothelial cells The endothelium is a single layer of squamous endothelial cells that line the interior surface of blood vessels and lymphatic vessels. The endothelium forms an interface between circulating blood or lymph in the lumen and the rest of the vessel ...

are counted underneath a

specular microscope Specular reflection, or regular reflection, is the mirror-like reflection of waves, such as light, from a surface. The law of reflection states that a reflected ray of light emerges from the reflecting surface at the same angle to the surf ...

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. The EBAA has established comprehensive medical standards for eye banks, and the standardized the training and certification of eye bank technicians. These interventions are considered major contributions to the current safety of eye transplantation. 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. 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 The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy– Kassebaum Act) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1 ...

, 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.

References

External links