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corneal transplant surgery under topical anaesthesia

Introduction. Penetrating keratoplasty (PKP) is performed under general anaesthesia or using retrobulbar or peribulbar anaesthesia1 combined with seventh cranial nerve akinesia. Segev F et al2 describes a combined topical anaestheic (Tetracaine 0.5%) and intracameral lidocaine and intravenous sedation for repeat PKP. We investigated the anaesthetic aspect of this procedure and describe a case series of corneal transplant surgery under topical anaesthesia. .

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corneal transplant surgery under topical anaesthesia

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    1. Corneal transplant surgery under topical anaesthesia Mr Shahram Kashani BSc MRCP MRCOphth Mr Charles CLAOUÉ MA, MD, DO, FRCS, FRCOphth, FEBO, MAE Queens Hospital, London United Kingdom

    3. Purpose To evaluate safety and efficacy of topical anaesthesia using Tetracaine 1% drops whilst performing corneal transplant surgery (penetrating keratoplasty and lamellar corneal graft).

    4. Setting and Methods Queens Hospital, London A consecutive case series of 4 patients (5 eyes) described with Tetracaine 1% as the sole anaesthetic agent Single surgeon performing all cases

    5. Case demographics 3 eyes penetrating keratoplasty 2 eyes lamellar corneal graft Age range 68 – 82 yrs old Age mean 76 yr sd +/- 6.6 Sex 2 males 2 females

    6. Primary vs Redo and associated operations 2 eyes redo grafts ( both PKP) 3 primary procedure (1 PK and 2 Lamellar grafts) No other additional operations were carried out during the surgery this time

    7. Indications and ocular co morbidity Case 1 (1 PKP , 1 lamellar graft) Indication : bilateral simultaneous corneal perforations Ocular history : chronic narrow angle glaucoma and dry eyes Case 2 ( lamellar graft) Indication : left perforated Descmetocele Ocular history : old left ocular trauma and corneal opacity

    8. Pre and 1 week Post op (case 1) Right top & Left bottom

    9. Indications and ocular co morbidity Case 3 (PKP) Indication : rejection and corneal decompensation post primary graft for right bullous keratopathy Ocular history : right angle closure glaucoma, previous right phakotrabeculectomy and right PKP Case 4 (PKP) Indication: rejection post primary graft for right herpetic Keratitis Ocular history: right PKP

    10. Complications No intra operative and immediate post operative (first week) complications were noted in any of the cases. In one patient (case 2) the intra ocular pressure remained high and a double chamber was formed which did not resolve with injection of C3F8 or corneal suturing. He is awaiting left PKP.

    11. Conclusion Corneal transplant surgery under topical drops appears to be a safe procedure although the case selection is the main factor in its success 1 Agrawal V, Tharoor M. Peribulbar anaesthesia for penetrating keratoplasty. A case series. Indian J Ophthalmol. 2002 Dec;50(4):313-6. 2 Sagev F, Voineskos A, Hui G, Law M, Paul R, Chung F and Slomovic A. Combined topical and intracameral anesthesia in penetrating keratoplasty. Cornea. 2004 May;23(4):372-6

    12. Financial interests and contact information Mr Shahram Kashani : I have received travel expenses from Bausch & Lomb (Pharmaceuticals) for this meeting. Mr Charles CLAOUÉ : paid consultant to Bausch & Lomb (Pharmaceuticals) and Rayner Intraocular Lenses; He has also received travel expenses from AMO. Author contact detail Shahdoc@hotmail.com +4477 716511

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