INTRODUCTION:

There are currently an estimated 15 million blind people in India. 6.8 million of these suffer from corneal blindness with vision less than 6/60 in at least one eye, and of these, about 1 million have bilateral corneal blindness. If the present trend continues, it is expected that the number of corneal blind individuals in India will increase to 10.6 million in 2020.

Corneal Blindness:

Corneal blindness means that one’s cornea, which is the transparent and thin outer layer of eye, becomes clouded due to nutritional deficiency, injury, or disease such as trachoma, corneal ulcer, conjunctivitis etc., and leading to loss of vision. The blindness can be cured in most cases by corneal grafting. Corneal grafting is performed in a patient when a voluntary donor pledges and donates his / her eyes after death.

Status Of Donor Eyes In India:

There is a severe lack of donor eyes in India and only 4.500 operations are being performed every year, while 30,000 new victims are added each year to the long list of 7 lakh patients already waiting to be cured. Although there are enough qualified surgeons and plenty of potential patients, corneal transplantation cannot be carried out due to lack of donor corneas. Eye donation means people pledging to donate their eyes after death to be used for corneal grafting for restoring sight to corneal blind people. In India there are more than 80 lakh deaths every year but sadly the corneal donations do not exceed a few thousand.

Factors Influencing Eye Donation:

The reasons for very low number of eye donations are manifold

· Lack of awareness in general public

· Improper development of infrastructure

· Absence of motivation even among the trained personnel or

· Social and religious taboos

Eye Bank:

Eye bank is a place at which corneas obtained from human bodies immediately after death are stored and preserved for subsequent transplantation to patients with corneal defects.

Functions Of Eye Bank:

1) Provide a round the clock public response system over the telephone.

2) Conduct public awareness programs on eye donation.

3) Co-ordinate with donor families and hospitals to motivate eye donation.

4) To process and evaluate the collected tissue.

5) To distribute tissue in an equitable manner.

6) To ensure safe transportation.

Sources Of Human Donor Eyes:

· Willing donation of one’s own eyes after death.

· Consented eyes.

· Eyes from medico legal and pathological post mortem cases.

· Eyes from unclaimed bodies.

Good Donor Cornea:

Eyes removed soon after death from a person belonging to age group of 10 to 15 years who died suddenly due to acute episode provides the best donor cornea.

However large number of eyes received is from older age group with possibility of lower endothelial cell count.

Points To Be Remembered:

Remember the following after making the call to the Eye Bank

· Keep the eyes of the deceased closed and covered with moist cotton.

· Switch off the ceiling fan, if any, directly over the deceased person.

· If possible, apply antibiotic eye drops periodically in the deceased’s eyes to reduce the chance of any infection.

· Raise the head of the deceased by about six inches, if possible, to reduce the chances of bleeding at the time of removal of the eyes.

Enucleation:

Eyes should be enucleated soon after death. A relatively longer interval of 4 to 6 hours may be allowed in winter months. But in summer must be enucleated within two to three hours from death. The eyes should carry the following information about the donor:

Ø Age and sex.

Ø Cause of death

Ø Time and date of death

Ø Time and date of enucleation

Enucleation should be done aseptically and the eyeballs should be transported to the eye bank in a wide mouth sterile glass bottle in an ice box or thermos flask. The eyeballs are washed with normal saline, antibiotic drops instilled and the cornea is examined with good illumination and magnification, preferably with slit lamp. Clinical viability is graded depending upon the degree of stromal oedema and folds. Usable eyeballs are then transferred to autoclaved wide mouth bottles containing sterile cotton gauze pad. Adequate antibiotic solution is instilled to moisten the pad. The eyeball rests on the pad with cornea straight up and without touching any part of the bottle. 10ml of venous blood should be collected in sterile bottle for serological examination.

Contraindications For Collection Of Donor Eyes

· Systemic Causes

· Ocular causes

· AIDS

· Hepatitis B

· Rabies

· Severe Burn

· Malignancy, Leukemia, Lymphoma

· Death from unknown causes

· Corneal opacities and dystrophy

· Retinoblastoma, malignant melanoma

· Active inflammatory diseases, e.g. conjunctivitis, iridocyclitis, endophthalmitis

· Congenital abnormalities, e.g. keratoconus, keratoglobus.

· Prior refractive procedures, e.g. radial keratotomy, laser photo ablation

· Anterior segment surgical procedures e.g. cataract, glaucoma.

Preservation of Donor Eye:

· Short term preservation (up to 96 hours)

o Moist chamber method – whole globe is preserved in a moist chamber at 4⁰C in a refrigerator for 24 hours.

· MK (Mc Carey Kaufman) medium – It consists of tissue culture – 199 5% Dextran – 40, HEPES buffer to adjust pH at 7.4, Gentamycin 0.1 mg/ml,

· Intermediate term preservation (up to 2 weeks)

o K-SOL medium, dexol medium, optisol medium, etc., are used for preservation.

· Long term preservation (months to years)

o Viable organ culture method, cryopreservation.

o Non viable glycerine preservation.

Corneal Transplantation:

It also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft) in its entirety (penetrating keratoplasty) or in part (lamellar keratoplasty) A cornea transplant can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea.

Promoting Awareness about Eye Donation:

Eye Bank Association of India’s Mission is to continuously educate general public about preventing blindness caused due to corneal disorders and wherever cure is required facilitate availability of cornea in the shortest possible time. Nurses are the unique person in this noblest work.

CONCLUSION:

Becoming an eye donor can be one of the most important decisions we will make in our life. Our decision to be a donor can mean sight for someone struggling with vision impairing eye diseases. Eye Donation ; Let it be your family tradition.

Received on 01.07.2012 Modified on 22.09.2012

Asian J. Nur. Edu. and Research 2(4): Oct-Dec. 2012; Page 175-176