## Eye Banks
- Moorfields
- East Grinstead
- Manchester
- Bristol

## Consent to donation
- Must be respected if given by a person (cannot be over-ridden) but may also be granted by a nominated representative
- Donors must be informed that not every cornea is useable but that this cannot be known until the tissue is collected

## Indications
- Optical
    - Bullous keratopathy
    - Keratoconus
    - Corneal dystrophy
    - Scarring
    - Failed grafts

- Tectonic
    - Perforation
    - Thinning

- Therapeutic
    - Infective keratitis

## Eye retrieval
- Enucleation can be undertaken up to 24 hours after death
- Blood samples must be taken within 24 hours too
- Must be undertaken by a competent person
- Must confirm consent and check all relevant sources of information
- NHS Blood and Human Tissue Transport Box
- Donor identification: using wrist/angle tag

## Poor prognostic factors
- Ocular inflammation
- Corneal vascularisation
- Glaucoma
- Ocular surface disease/lid abnormality

## Contraindications to donation

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- Systemic disease
    - CNS
        - CJD
        - CMV encephalitis

    - Infections
        - Rubella
        - Rabies
        - Hepatitis
        - AIDS
        - Syphilis

    - Malignancy
        - Leukaemia
        - Lymphoma
        - Metastatic malignancies otherwise

- Ocular disease
    - Previous intraocular surgery
    - Glaucoma
    - Iritis
    - Intraocular tumours

- Age
    - &lt;1 year old: corneas too small/friable

- Severe haemodilution pre-mortem

## Complications
- Early
    - Wound leak: hypotony
    - Raised IOP: retained viscoelastic, pupil block
    - Persistent epithelial defect
    - Endophthalmitis
    - Disease recurrence
    - Graft failure

- Late
    - Rejection
    - Infection
    - Disease recurrence
    - Astigmatism
    - Persistent iritis (Urrets-Zavalia syndrome with fixed dilated pupil)
    - Late failure
    - Glaucoma

- Other
    - Cataract
    - RD
    - Expulsive haemorrhage
    - CMO

## Higher risk of graft rejection
- Younger patient
- Blood group incompatibility: Collaborative Corneal Transplant Study found that blood group matching may reduce risk of graft failure
- Repeat graft
- Large graft
- Eccentric graft
- PAS
- Exposed sutures
- Deep stromal vascularisation
- Pre-existing glaucoma
- Ocular surface disease
- Iritis

## Graft rejection
- Type 4 immune reaction
- Typically occurs after 2 weeks post-op
- Epithelial
    - Epithelial rejection line: lymphocytes
    - Quiet eye

- Subepithelial rejection
    - Nummular infiltrates

- Stromal rejection
    - Symptomatic: reduced vision, red eye, pain
    - Anterior chamber activity
    - Stromal oedema

- Endothelial rejection
    - Khodadoust line

### Management of graft rejection
- Should be suspected early, especially in any graft patient with intrao-ocular inflammation
- May be challenging to manage
- Intensive topical steroids
- Consideration of systemic steroids (including IVMP) if severe/worsening rejection or especially if evidence of endothelial rejection

Eye Banks Moorfields East Grinstead Manchester Bristol Consent to donation Must be respected if given by a person (cannot be over-ridden) but may also be…

Cornea

Corneal Grafts

Intro

FRCOphth Part 2 Study Notes

Tumours, masses and neoplasia

Tumours overview

Uveitis

Uveitis background

Anterior uveitis

Intermediate uveitis

Uveitis in JIA

Uveitis with JIA

Retinal vasculitis

Sarcoidosis

Behcet's disease

Toxoplasmosis

Viral uveitis

Strabismus

Overview

Esotropia

Fungal uveitis

Mycobacterial uveitis

Adnexal masses

Spirochaetal uveitis (including Syphilis)

Exotropia

Melanoma

Nematode uveitis

Retinoblastoma

Retinoblastoma (for Part 2)

Incomitent

Voyt-Koyanagi-Harada syndrome

Conjunctival intraepithelial neoplasia

Vertical deviations

Sympathetic ophthalmia

Orbit and ocular adnexae

Orbit

AV Malformations and hamartomas

Arteriovenous malformations and hamartomas

Restriction syndromes

Paediatrics

Leucocoria

Congenital Cataract

Paediatric Glaucoma

Retinopathy of prematurity

Retinopathy of Prematurity

ROP-like disorders

Congenital nasolacrimal duct obstruction

White dot syndromes

Aniridia: Short Arm 11 Deletion (11p13)

Choristomas

Management Of Amblyopia

Alphabet patterns

Scleritis

Iris Nodules

Meningioma

Strabismus surgery

Optic nerve glioma

Lymphoma

Extraocular Muscles

Rhabdomyosarcoma

Idiopathic orbital inflammation

Orbital neuroblastoma

Anterior Persistent Foetal Vasculature

Lacrimal system

Metastatic lesions

Surgical Retina

Retinal Detachment

Vitreoretinal Interface And Macular Hole

Epiretinal Membrane

Medical Retina

Diabetic Eye Disease

Orbital Blood Vessels

Retinal Vascular Disease

Macular Degeneration

Central Serous Chorioretinopathy (CSCR)

Sickle Cell Retinopathy

Retinitis Pigmentosa

Albinism

Retinal Telangiectasias

Miscellaneous Retinopathies

Atropine And Myopia Progression

Pharmacology

Side Effects Of Systemic Drugs

Foetal Alcohol Syndrome

Neuro-ophthalmology

Optic Neuropathy

Papilloedema

Idiopathic Intracranial Hypertension

Chiasmal Disorders

Retrochiasmal Disorders

Migraine

Paranasal Sinuses

Supranuclear Motility Disorders

Third Nerve Palsies

Fourth Nerve Palsies

Sixth Nerve Palsies

Seventh Nerve Palsies

Anisocoria

Myasthenia Gravis

Myopathies

Blepharospasm

Functional Visual Loss

Lacrimal Glands

Phakomatoses

Developmental diseases

Tear Film

Eyelids

Blinking

Lid Malpositions

Anterior segment - ocular surface

Conjunctiva

Conjunctivitis

Sclera

Pigmented Conjunctival Lesions

Squamous Cell Carcinoma Of The Conjunctiva

Ocular Cicatricial Pemphigoid

Corneal Structure And Development