EYE DONATION & CONDITIONS

WHERE KERATOPLASTY IS DONE

- HARRISH SA
029
EYE DONATION
Collection, storage and distribution of cornea for the purpose
of corneal grafting, research and supply of the eye tissue for
other ophthalmic purposes.
Functions of an eye bank
Promotion of eye donation
Registration
Collection
Receiving and processing
Preservation
Distribution
Research activities
EYE COLLECTION CENTRE
Peripheral satellites of an eye bank for better functioning.
One collection centre for urban population of 200000. About 4–5
collection centres are attached with each eye bank.
Functions of eye collection centre are:
• Local publicity for eye donation.
• Registration of voluntary donors.
• Arrangement for collection of eyes after death.
• Initial processing, packing and transportation of collected eyes to
the attached eye bank. Personnel needed for eye collection centre are:
1. Ophthalmic technician trained in eye bank.
2. Local honorary workers/voluntary agencies like Lions Club, Rotary
Club, etc. to boost the eye donation campaign.
3. Services of honorary ophthalmic surgeon or medical officer trained
in enucleation available on call.
• Almost anyone at any age can pledge to donate eyes after
death; all that is needed is a clear healthy cornea.
• The eyes have to be removed within six hours of death.
• Eye donation gives sight to two blind persons as one eye is
transplanted to one blind person.
• The eyes can be pledged to an eye bank and can be
actually donated to any nearest eye bank at the time of
death.
• The donated eyes are never bought or sold. Eye donation is
never refused.
• The eyes cannot be removed from a living human being in
spite of his/her consent and wish.
 CORNEAL EDEMA
The water content of normal cornea is 78%. It is kept
constant by a balance of factors which draw water in
the cornea and the factors which draw water out of
cornea.
Disturbance of any of the above factors leads to
corneal oedema, wherein its hydration becomes above
78%, central thickness increases and transparency
reduces.
Causes of corneal oedema
1. Raised intraocular pressure
2. Endothelial damage
3. Epithelial damage
Clinical features
Stromal haze with reduced vision.
Loss of vision, pain, discomfort and photophobia.
Treatment
Conservative Management
Penetrating keratoplasty is required for long- standing
cases of corneal oedema, non-responsive to
conservative therapy.
CORNEAL ULCER
Corneal ulcer may be defined as
discontinuation in normal epithelial
surface of cornea associated with
necrosis of the surrounding corneal
tissue.
Treatment of impending perforation:
Penetrating therapeutic keratoplasty can
be done.
Treatment of perforated corneal ulcer:
Depending upon the size of perforation
and availability, measures like use of
tissue adhesive glues, covering with
conjunctival flap, use of bandage soft
contact lens or therapeutic keratoplasty
should be undertaken. Best option is an
urgent tectonic keratoplasty.
CORNEAL OPACITY
Loss of normal transparency of
cornea due to scarring.
Causes
1. Congenital opacities may occur as
developmental anomalies or
following birth trauma.
2. Healed corneal wounds.
3. Healed corneal ulcers.
Clinical features
Corneal opacity may produce loss
of vision
Blurred vision
Treatment
Penetrating keratoplasty is done in
the case of leucomatous opacity
CALCIFIC DEGENERATION (BAND SHAPE
KERATOPATHY)
Band shape keratopathy (BSK) is essentially
a degenerative change associated with
deposition of calcium salts in Bowman’s
membrane, most superficial part of stroma
and in deeper layers of epithelium.
Etiology
Ocular diseases
Metabolic
Age related
Clinical features
It typically presents as a band-shaped opacity
in the interpalpebral zone with a clear
interval between the ends of the band and
the limbus.
Treatment
Chelation
PTK
Keratoplasty is done where vision is fully
obscured
SALZMANN’S NODULAR DEGENERATION

Etiology: This condition occurs in eyes

with recurrent attacks of phlyctenular
keratitis, rosacea keratitis and
trachoma.
Pathogenesis. In Salzmann’s nodular
degeneration, raised hyaline plaques
are deposited between epithelium and
Bowman’s membrane.Associated with
destruction of membrane.
Clinical features:
Clinically, one to ten bluish white
elevations (nodules), arranged in a
circular fashion.
Vision loss
Discomfort
SPHEROID DEGENERATION
a.k.a Climatic droplet
keratopathy/Labrador keratopathy/
Bietti’s nodular dystrophy/corneal
elastosis
Etiology:
It typically occurs in men who work
outdoors, especially in hostile climates.
Clinical features:
In this condition, amber-coloured
spheroidal granules (small droplets)
accumulate at the level of Bowman’s
membrane and anterior stroma in the
interpalpebral zone.
Treatment in advanced cases is by corneal
transplantation.
TERRIEN’S MARGINAL DEGENERATION

Terrien’s marginal degeneration is non-

ulcerative thinning of the marginal cornea.
Clinical features:
Mostly involves superior peripheral
cornea.
Initial lesion is asymptomatic corneal
opacification separated from limbus by a
clear zone.
The lesion progresses very slowly over
many years with thinning and superficial
vascularization.
Dense yellowish white deposits.
Irritation and defective vision.
Treatment is non-specific. In severe
thinning, a patch of corneal graft may be
required.
HYALINE DEGENERATION
Hyaline degeneration of cornea is
characterised by deposition of hyaline
spherules in the superficial stroma and
can be primary or secondary.
1. Primary hyaline degeneration is
bilateral and noted in association with
granular dystrophy.
2. Secondary hyaline degeneration is
unilateral and associated with various
types of corneal diseases including old
keratitis, long-standing glaucoma,
trachomatous pannus. It may be
complicated by recurrent corneal erosions.
Treatment of the condition when it causes
visual disturbance is keratoplasty.
PSEUDOPHAKIC BULLOUS
KERATOPATHY
Pseudophakic bullous
keratopathy is usually a
continuation of
postoperative corneal
oedema produced by surgical
or chemical insult to a
healthy or compromised
corneal endothelium.
PBK is becoming a common
indication of penetrating
keratoplasty (PK).
KERATOCONUS
Keratoconus (conical cornea ) is a non-
inflammatory bilateral (85%) ectatic
condition of cornea in its axial part.
Etiopathogenesis. It is still not clear.
Clinical features:
Patient presents with a defective vision due
to progressive myopia and irregular
astigmatism, which does not improve fully
despite full correction with glasses.
Treatment
Spectacle correction
Contact lenses
Corneal collagen crosslinking with
riboflavin(CXL or C3R) and UV-A rays may
slow the progression of disease.
Keratoplasty may be required in later
CORNEAL DYSTROPHIES
Cells have some inborn defects due to
which pathological changes may
occur with passage of time leading to
development of corneal haze in
otherwise normal eyes that are free
from inflammation or vascularisation
 III. Stromal dystrophies

IC3D CLASSIFICATION 1. TGFb1 corneal dystrophies

a. Lattice corneal dystrophy
I. Epithelial and subepithelial dystrophies
1. Epithelial basement membrane dystrophy b. Granular corneal dystrophy
(EBMD). 2. Macular corneal dystrophy (MCD).
3. Schnyder corneal dystrophy (SCD).
2. Epithelial recurrent erosion dystrophy (ERED).
3. Subepithelial mucinous corneal dystrophy 4. Congenital stromal corneal dystrophy (CSCD).
(SMCD). 5. Fleck corneal dystrophy (FCD).
6. Posterior amorphous corneal dystrophy
4. Mutation in keratin genes: Meesmann corneal
(PACD).
dystrophy (MECD).
7. Central cloudy dystrophy of Francois (CCDF).
5. Lisch epithelial corneal dystrophy (LECD).
8. Pre-Descemet corneal dystrophy (PDCD).
6. Gelatinous drop-like corneal dystrophy
IV. Descemet membrane and endothelial dystrophi
(GDLD).
1. Fuchs endothelial corneal dystrophy (FECD).
II. Bowman layer dystrophies 2. Posterior polymorphous corneal dystrophy (PPC
1. Reis-Bucklers corneal dystrophy (RBCD) 3. Congenitalhereditaryendothelialdystrophy1 (CH
Granular corneal dystrophy type 3. 1).
2. Thie-Behnke corneal dystrophy (TBCD). 4. Congenitalhereditaryendothelialdystrophy2 (CH
2).
3. Grayson-Wilbrandtcornealdystrophy(GWCD).
5. X-linked endothelial corneal dystrophy (XECD).
Treatment is based on the thickness of the cornea
involved.
Keratoplasty is done either lamellar or penetrating.
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