The EBAI CME 2013 - 21st and 22nd of September 2013, Golden Valley Resort, Ghodbunder Road, Thane West, Mumbai.

1. Triple Corneal Transplant
One donor cornea for three recipients
Professor Radhika Tandon
Faculty in charge National Eye Bank
Dr Rajendra Prasad Centre for Ophthalmic Sciences
AIIMS

2. Magnitude of Blindness (WHO-2011)
39.4
8.9
Global blindness
India (In millions)
 20% of global blindness
 80% is avoidable (preventable and treatable)

3. Cataract-
51%
Glaucoma-8%
AMD-5%
Childhood
BL-4%
CO-4%
Trachoma-3%
RE-3%
DR-1%
undetermined
-21%
Causes of blindness– WHO 2011

4. Causes of Blindness in India
Cataract
62.6%
Ref. Errors
19.7%
Glaucoma
5.8%
Post. Seg.
Disorders
4.7%
Corneal
Blindness
1%
Surgical
Comp.
1%
Others
5.2%
(Source: Current estimates of Blindness in India, BJO, March 2005)

5. Donor cornea availability
0
20000
40000
60000
80000
100000
Requirement Actual collection
100000
30,000
Corneas per year

6. How to overcome the shortfall?
 Long term measures
Effective
EDCs
Efficient
eye banks
and
personnel
Awareness
and
motivation
among
people

7. 1 donor cornea for 3 recipients
 In short term,
Anterior
lenticule • ALTK
Posterior
lenticule
• DSAEK
• DLEK
Limbal
stemcell • LSCT

8. 1 donor cornea for 3 recipients
ALTK
DSAE
K
STEM
CELLS for
LSCT

9. Preparation of Donor cornea
Trephines for host cornea
Microkeratome with
blade
Artificial anterior
chamber
Moria microkeratome
machine

10. • Mount the cornea over
artificial chamber
• Pass a microkeratome of
desired depth of cut

11. • Remove the anterior
lenticule
• Harvest two limbal stem cell
lenticules of 6x2mm each

12. • Cut the posterior lenticule
with trephine of desired
size
• Transplant each lenticule in
appropriate patients

13. Anterior lenticule
 Used in ALTK procedures for treating opacities
involving anterior half of corneal stroma
 Good interface apposition and less haze
 Early visual rehabilitation
 Less chance of rejection
 Longer graft survival

14. Indications for ALTK
Trachomatous
keratopathy
Salzmann nodular
degeneration
Keratoconus
ALTK

15. Posterior lenticule
 Used in DSAEK and DLEK for treating patients
with endothelial decompensation without stromal
scarring.
 Minimal or no suture induced astigmatism

16. Indications of DSAEK
PBK CHED Fuchs’
Dystrophy
DSAEK

17. Limbal stem cells
 Used to replenish stem cells in patients of
bilateral total stem cell deficiencies like
OCP, SJS etc.
 Simple and effective procedure
 Used with AMG for better results
PRE-
OP
POST-
OP

18. Advantages
 Reduces the backlog of patients with corneal
blindness in countries in which there is a dearth
of good-quality donor corneal tissue
 Good surgical outcome and faster rehabilitation
 Growing trend towards lamellar procedures
 Precut tissue can be transferred to other
transplant centers without compromising quality

19. Disadvantages
 Cost
 Surgical expertise
 Availability of suitable patients at all time
 Need for effective donor tissue distribution
system

20. Thank you

22. Asia ARVO 2013
28-31 October 2013

23. Innovating & Converging
Technologies
in Vision Research
Hosted by IERG-ARVO IC
&
Dr Rajendra Prasad Centre for Ophthalmic
Sciences, AIIMS

24. Ashoka Hotel & Convention
Centre
New Delhi