CORNEA TRANSPLANT FOUNDATION - APPLY NOW - SICSSO - CORNEA FOUNDATION FOR DEVELOPING COUNTRY

FOUNDATION ONLINE APPLICATION

Contact Informations
Name
First Last
Designation
- MD
- PhD
Company / Organization / Institutions
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Assessment Survey
Surgical room
Ophthalmic surgical room?
- No
- Yes
Ophthalmic surgical room
Please enter a number from 0 to 10.
General surgical room?
- No
- Yes
General surgical room number
Please enter a number from 0 to 10.
Type of microscope (Brand and model):
Microscope accessories: ocular for the 2nd surgeon?
- No
- Yes
Monitor connection
- No
- Yes
Autoclave type (Brand and model):
Sterilization cycle time:
Surgical Instruments
Please upload pictures of your surgical set and disposable materials
Drop files here or
Non-disposable
Please provide a list of non-disposable surgical instruments for corneal transplant
Disposable
Please provide a list of disposable surgical instruments for corneal transplant
Ecobiometer
- No
- Yes
BRAND MODEL OF Ecobiometer
Phaco Machine
- No
- Yes
BRAND MODEL OF Phaco Machine
Vitrectomy Machine
- No
- Yes
BRAND MODEL OF Vitrectomy Machine
Tomography Machine
- No
- Yes
BRAND MODEL OF Tomography Machine
Anterior Segment OCT
- No
- Yes
BRAND MODEL OF OCT
Endothelial cell count specular microscopy
- No
- Yes
BRAND MODEL OF MICROSCOPY
Accessibility to anesthesia - LOCAL
- No
- Yes
Accessibility to anesthesia - GENERAL
- No
- Yes
Accessibility to Accessibility to hospitalization
- No
- Yes
N° beds available
Please enter a number from 0 to 9999.
Do you have an Eye Bank in your country?
- Yes
- No
Can your Eye Bank provide enough tissues for the Mission?
- Yes
- No
Can your Eye Bank provide pre-cut tissues for DSAEK?
- Yes
- No
Can your Eye Bank provide pre-stripped tissues for DMEK?
- Yes
- No
Do you need us to provide tissues for the Mission?
- Yes
- No
Are there any laws in your Country for cornea importation?
- Yes
- No
Details of the closest Eye Bank (name, address and contact information)
History with your current eye bank
Surgical capacity for corneal transplantation that this eye bank serves
Type of available tissues
- PK
- DALK
- Pre-cut DSEK
- Pre-cut DMEK
Cost of tissues
PK
DALK
DSEK
DMEK
Who provides your corneal tissues?
Human resources
Number of ophthalmologists to be trained by SICSSO
Please enter a number from 1 to 100.
Please upload your surgeons essential CV including age, experience in anterior segment surgery (number and type of procedures), experience in corneal surgery (number and type of procedures).
Drop files here or
Number and experience of ophthalmology assistants ( optometrist, technicians, nurses, ect.)
Scrub nurse
- Yes
- No
Number of Scrub nurse
Please enter a number from 1 to 99.
Please specify whether you have scrub nurse and their experience with corneal transplant, cataract and other anterior segment surgeries
Please inform us about any legal obligation or government authorization required to proceed with the Mission
Type of training requested (multiple choice allowed):
- DALK
- DSEK
- DMEK
- OSST ( Ocular Surface Stem Cell Transplantation)
- Pterygium and ocular surface tumor surgery
Financial resources SICSSO is a non-profit organization and our teachers are unpaid volunteers. All the other costs to accomplish the mission will be counted basing on the information provided in this application. Any legal form of sponsorship is accepted. The applicant will receive the Mission budget. In case he can fully cover the costs, the mission will certainly be carried out, once received the government authorization. In cases of partial or external contribution, the realization and the timing of the mission will depend on the finding of funds.
Budget

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Ph. + 39 3317073818
E-mail: info@sicsso.org
Via Mazzini, 60
58100 Grosseto, Italy

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