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CORNEAL SURGERY

CORNEAL SURGERY. 1. Penetrating keratoplasty. 2. Keratoprosthesis. 3. Refractive surgery. Radial keratotomy. Photorefractive keratectomy (PRK). Laser in-situ keratomileusis (LASIK). Non-contact laser thermal keratoplasty. Penetrating Keratoplasty. 1. Indications.

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CORNEAL SURGERY

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  1. CORNEAL SURGERY 1. Penetrating keratoplasty 2. Keratoprosthesis 3. Refractive surgery • Radial keratotomy • Photorefractive keratectomy (PRK) • Laser in-situ keratomileusis (LASIK) • Non-contact laser thermal keratoplasty

  2. Penetrating Keratoplasty 1. Indications • Optical (e.g. bullous keratopathy, dystrophies) • Tectonic (e.g. severe stromal thinning, descemetocele) • Therapeutic (e.g. severe keratitis) • Cosmetic 2. Adverse prognostic factors • Severe stromal vascularization • Absence of corneal sensation • Progressive conjunctival inflammation (e.g. pemphigoid) • Tear film dysfunction • Glaucoma

  3. Technique of penetrating keratoplasty a, b - Excision of host tissue Excision of donor tissue c - Fixation of donor tissue

  4. Signs of late graft rejection Epithelial Subepithelial opacities Linear epithelial opacity Endothelial Iritis and inflammation at graft-host junction Endothelial precipitates (Khodadoust line) Treatment • Intensive topical and periocular steroids • Occasionally systemic steroids

  5. Keratoprosthesis Indications Technique Insertion of artificial lenticule into corneal stroma Bilateral blindness from ocular pemphigoid, chemical burns or repeated graft failure Main complications • Retrolenticular membrane formation • Glaucoma

  6. Radial keratotomy • Decreases myopia by flattening cornea • Deep incisions from edge of optical zone to limbus Main indications Main complications • Stable myopia of up to 8D • Accidental perforation • Otherwise normal cornea • Intrastromal epithelial cysts

  7. Photorefractive keratectomy ( PRK ) Indications • Stable myopia up to 6D with astigmatism no more than 3D • Hypermetropia up to 2.5D Technique Main complication Subepithelial haze which usually resolves after 1-6 months Reshaping of cornea by excimer laser ablation of Bowman layer and anterior stroma

  8. Laser in-situ keratomileusis (LASIK) Indications - similar to PRK but corrects higher degrees of myopia Technique Complications • Wrinkles in flap • Thin flap of cornea fashioned • Cellular interface proliferation • Bed treated with excimer laser • Flap repositioned

  9. Non-contact laser thermal keratoplasty Indications • Patients over 40 years with hypermetropia up to 2D • Following overcorrection of myopia • Corneal curvature is steepened by application • of laser heat to stroma • Holmium laser spots applied to mid-cornea

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