KERATOPLASTY

types

1. penetrating 

2. lamellar

COMMON INDICATIONS

1. OPTICAL: To improve vision

2. TECTONIC: To restore anatomy of eye as in corneal perforation

3. THERAPEUTIC: To treat infection as in non-healing corneal ulcer

4. COSMETIC: To improve look of eye

method

1. Excision of the donor eye—It must be done as early as possible, i.e. within 6 hours after death.

2. Excision of the donor’s cornea—An ideal size of the donor is 7.5 mm. done by trephine.

3. Excision of diseased host cornea—It is done by a trephine

4. Fixation of donor’s graft—It is done by continuous 10.0 nylon sutures.

COMPLICATIONS 

Early complications

1. persistent epithelial defects

2. loose or protruding sutures (risk of infection marked sterile reaction, papillary hypertrophy)

3. wound leak (sometimes with flat anterior chamber or iris prolapse),

4. Uveitis

5. elevation of intraocular pressure

6. traumatic graft rupture

7. cystoid macular oedema

8. microbial keratitis 

9. endophthalmitis

10. rejection

11. A rare complication is a fixed dilated pupil (Urrets–Zavalia syndrome).

• Late complications

1. astigmatism

2. recurrence of underlying disease

3. late wound dehiscence

4. retrocorneal membrane formation

5. glaucoma

6. rejection

7. failure without rejection.

EYE BANKING

OBJECTIVE: is to collect and store cornea and make it available for corneal transplantation

EQUIPMENT: 

1. REFIGERATOR with temperature recording device

2. operation theatre

3. slit lamp

4. sterilization facility

5. enucleation and corneal incision instruments

IT MAY ALSO HAVE

1. incubator

2. specular microscope

3. ice machine

4. microbiology facility

5. centrifuge

ENUCLEATION

DONE with in 6 hours of death

LABEL:

1. Age and sex.

2. Cause of death.

3. Time and date of death.

4. Time and date of enucleation.

Enucleation done aseptically and the eyeballs 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. 

PRESERVATIVES

1. SHORT TERM UPTO 96 HRS

   1. moist chamber method: refrigerate at 4 centrigrade for 24 hours

   2. McKarey -kaufman medium: refrigerate at 4 centigrade for 96 hrs

2. INTERMEDIATE TERM UP TO 2 WEEKS

   1. K-sol medium

   2. dexol medium

   3. optisol medium

3. LONG TERM MONTHS TO YEARS

   1. viable: 

      1. organ culture medium

      2. cryopreservation

   2. non viable

      1. glycerine preservation