Removal Of Cornea For Transplantation

CONTRAINDICATIONS The Eye Bank Association of America (EBAA) (7) and the Food and Drug Administration (FDA) have stringent standards and regulations for tissue that is to be used for transplantation. This has made it necessary for trained personnel who are aware of the ever-changing requirements to be responsible for the retrieval and processing of such tissue.

At the time of writing, the EBAA has a list of absolute contraindications that includes HIV, hepatitis B and C (social conditions that put the donor at risk for these entities are also considered contraindications), Creutzfeld-Jakob disease, ocular and intraocular inflammation, rabies, malignant tumors of the anterior segment, leukemia, lymphoma, and retinoblastoma.

The EBAA Medical Standards define the minimum standards of practice for the procurement, preservation, storage, and distribution of eye tissue for transplantation as determined by the ophthalmic medical community.

Fig. 7-3. Prosthetic mold. The material is composed of "Coecal Buff' dental stone (Coe Laboratories, Inc., Chicago, IL) that is placed in empty socket after removal of eye.

TECHNICAL ASPECTS Preferably, the enucleation is performed before the general autopsy procedure has commenced. The eye is removed by the anterior approach under aseptic conditions as soon as possible after death but within 24 h.

The eye is placed with the cornea directed upwards in a glass receptor that contains sterile saline (Fig. 7-4). The specimen is kept at 2-6°C in a refrigerator. If the eye is to be transported out of town, the moist chamber jar is placed in a Styrofoam container with plastic bags that contain chipped ice. Blood is collected from the donor (7-10 mL) for required serological testing. Contact with the local police or highway patrol will facilitate rapid transport to its destination.

Fig. 7-4. Eye for corneal transplantation. Eye positioned in sterile glass receptor with cornea directed upward. Sterile jar contains sterile saline to maintain moisture to cornea.
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