logging in or signing up KERATOPLASTY maha06066 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1775 Category: Entertainment License: All Rights Reserved Like it (1) Dislike it (0) Added: August 29, 2009 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: Simirachel (11 month(s) ago) Its really good. Well organized & Simple to follow.. Kindly send the same. Saving..... Post Reply Close Saving..... Edit Comment Close By: 123imc (11 month(s) ago) excellent.send or request for download Saving..... Post Reply Close Saving..... Edit Comment Close By: drjharnasingh (15 month(s) ago) nice Saving..... Post Reply Close Saving..... Edit Comment Close By: hondacbr143 (26 month(s) ago) super Saving..... Post Reply Close Saving..... Edit Comment Close By: sethuveliyath (31 month(s) ago) hi can u pls sent this file to my email id - sethuveliyath@hotmail.com, pls bcas my wife ,she is a nurse,she likes to present this for her in service education. Pls kindly send me Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript KERATOPLASTY : KERATOPLASTY P. MAHALINGAM BVM 06066 LAYERS OF CORNEA : LAYERS OF CORNEA Anterior epithelial layer Bowman’s membrane Corneal stroma Descemet’s membrane Enothelial layer INDICATIONS : INDICATIONS Corneal endothelial dystrophy & degeneration Opaque central corneal scars & blindness Deep corneal ulcers Graft rejection may occur –(post operative vascularization, edema,inflammation,eventual opacification of transplanted cornea) CORNEAL EDEMA : CORNEAL EDEMA CORNEAL ULCER : CORNEAL ULCER SOURCES OF CORNEAL GRAFTS : SOURCES OF CORNEAL GRAFTS Heterologous (from other spp) Homologous(from the same spp) Autlogous(from the same patient, usually a rotating or sliding graft) TYPES OF KERATOPLASTY : TYPES OF KERATOPLASTY Full thickness or penetrating keratoplasty Lamellar keratoplasty (corneal epithelium& anterior stroma) INSTRUMENTATIONS : INSTRUMENTATIONS Eyelid speculum(barraquer wire speculum) Flierringa rings(stabilize peripheral cornea,anterior sclera & anterior segments) Tissue fixation forceps Tenotomy or utility scissors Rt < handle corneal trasplantation scissors Microsurgical needle holders cont………… : cont………… Corneal trephines(8-12mm dia in 0.5 increments) Teflon corneal graft block RECOMMENDED SUTURES : RECOMMENDED SUTURES 4-0 to 6-0 braided sutures-temporarily attach the flieringa ring to limbus or sclera 7-0 to 8-0 nylon sutures –graft stabilization (8-16 simple interrupted sutures) 8-0 to 10-0 –simple continuous suture to supplement the interrupted sutures) PREPARATION OF DONOR CORNEA : PREPARATION OF DONOR CORNEA DONOR – should be free of infectious diseases Aseptically remove the globe – several drpos of neomycin,bacitracin,polymyxin-B Placed in sterile moist chamber-cornea upward(use within 7 days) Remove only cornea with 2mm of scleral rim(-20 degree – 18 months) cont………. : cont………. Prior to use epithelial & endothelial with descemet”s membrane surfaces are vigourously scraped leaving corneal stromal collagenous lamellae. PENETRATING KERTOPLASTY : PENETRATING KERTOPLASTY DEFINITION Affeted tissue removed full thickness(all layers of cornea) Replaced with donor button liner with viable endothelium TECHNIQUE : TECHNIQUE Lesion is removed with trephine set at 1mm depth. Trephine is withdrawn immediately on entering the anterior chamber Tissue tags trimmed from the incision edges with corneal scissors & fine forceps Donor button is washed with antibiotics cont…….. : cont…….. Cornea,5mm rim of sclera removed, epithelium is placed on teflon block & donor button is cut from the endothelial side with trephine Donor button is 0.5mm larger in dia than recipient bed to allow for shrinkage(endothelium must not be touched) cont………. : cont………. Donor button is removed & placed in the recipient bed with four cardinal sutures, one in each quadrant.Put interrupted or continuous sutures.After that cardinal sutures are removed. Anterior chamber then reconstituted with balanced salt solution & an air bubble POST OPERATIVE CARE : POST OPERATIVE CARE Topical antibiotics & corticosteroids- four times a day given - postoperatively Postoperative vascularization minimized by fine sutures(8-0 to 10-0 nylon) & corticosteroids(0.1 percent dexamethasone) Sutures removed after 12-18 days. cont,……… : cont,……… Hyaluronic acid & methycellulose in the anterior chamber & on the edges of corneal incision protects the corneal endothelium from surgical trauma. The material is irrigated from the eye after suturing. cont,…… : cont,…… Major problem -formation of protein rich plasmoid aqueous -shrinkage of the donor button -postoperative vascularization To minimize the formation of plasmoid aqueous : To minimize the formation of plasmoid aqueous -Systemic corticosteroids(oral prednisolone 1-2mg/kg daily for 3 days -Topical corticosteroids (dexamethasone 0.1 percent QID several days before surgery) -Topical antiprostaglandins (flurbiprofen or indomethacin) -Systemic antiprostaglandins (flunixin meglumine-1mg/kg I/v at induction -Acetyl salicylic acid-25mg/kg PO daily for 2 days before surgery) -Heparin & epinephrine (itraocular flushing solution) LAMELLAR KERATOPLASTY : LAMELLAR KERATOPLASTY DEFINITION Epithelium & superficial stroma are dissected free & replaced with donor tissue. TECHNIQUE : TECHNIQUE The area to be removed is outlined with a trephine set at 0.3mm Lesion removed with a corneal dissector & number 64 Beaver blade or scissors Donor eye – washed with antibiotic solution.The lamellar graft is removed from the donor eye with an electrokeratotome or a Martinez corneal dissector. cont……. : cont……. The graft is made 0.5mm larger than the recipient bed. The graft is sutured into the recipient bed with either a continuous suture with a burier knot or multiple interrupted sutures. Postoperatively topical antibiotics & corticosteroids are applied 4 times daily. AUTOGENOUS LAMELLAR CORNEAL TRASPLANTATION : AUTOGENOUS LAMELLAR CORNEAL TRASPLANTATION A square block of tissue is excised at the ulcer site for debridement & graft site preparation. A slightly larger graft is harvested by superficial keratectomy-on the same cornea or contralateral cornea. The graft is sutured into the recipient bed. It prevents the graft rejection, but vascularization of the site often occurs PENETRATING CORNEOSCLERAL ALLOGRAFT : PENETRATING CORNEOSCLERAL ALLOGRAFT Replacement of continuous cornea & sclera from adonor of the same species – treatment for canine epibulbar melanomas. Corneoscleral donor tissue is collected – as soon as possible before resection of the lesion & is kept on a sterile gauze pad moistened with balanced salt solution. cont……… : cont……… All traces of uveal tissues are removed from the graft to reduce the severity of postoperative immune reactions. The graft is sutured with 8-0 to 10-0 monofilament nylon. Eye is then treated with topical antibiotics & corticosteroids 4-6 times daily for 7-10 days. Slide 42: THANK YOU You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
KERATOPLASTY maha06066 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1775 Category: Entertainment License: All Rights Reserved Like it (1) Dislike it (0) Added: August 29, 2009 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: Simirachel (11 month(s) ago) Its really good. Well organized & Simple to follow.. Kindly send the same. Saving..... Post Reply Close Saving..... Edit Comment Close By: 123imc (11 month(s) ago) excellent.send or request for download Saving..... Post Reply Close Saving..... Edit Comment Close By: drjharnasingh (15 month(s) ago) nice Saving..... Post Reply Close Saving..... Edit Comment Close By: hondacbr143 (26 month(s) ago) super Saving..... Post Reply Close Saving..... Edit Comment Close By: sethuveliyath (31 month(s) ago) hi can u pls sent this file to my email id - sethuveliyath@hotmail.com, pls bcas my wife ,she is a nurse,she likes to present this for her in service education. Pls kindly send me Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript KERATOPLASTY : KERATOPLASTY P. MAHALINGAM BVM 06066 LAYERS OF CORNEA : LAYERS OF CORNEA Anterior epithelial layer Bowman’s membrane Corneal stroma Descemet’s membrane Enothelial layer INDICATIONS : INDICATIONS Corneal endothelial dystrophy & degeneration Opaque central corneal scars & blindness Deep corneal ulcers Graft rejection may occur –(post operative vascularization, edema,inflammation,eventual opacification of transplanted cornea) CORNEAL EDEMA : CORNEAL EDEMA CORNEAL ULCER : CORNEAL ULCER SOURCES OF CORNEAL GRAFTS : SOURCES OF CORNEAL GRAFTS Heterologous (from other spp) Homologous(from the same spp) Autlogous(from the same patient, usually a rotating or sliding graft) TYPES OF KERATOPLASTY : TYPES OF KERATOPLASTY Full thickness or penetrating keratoplasty Lamellar keratoplasty (corneal epithelium& anterior stroma) INSTRUMENTATIONS : INSTRUMENTATIONS Eyelid speculum(barraquer wire speculum) Flierringa rings(stabilize peripheral cornea,anterior sclera & anterior segments) Tissue fixation forceps Tenotomy or utility scissors Rt < handle corneal trasplantation scissors Microsurgical needle holders cont………… : cont………… Corneal trephines(8-12mm dia in 0.5 increments) Teflon corneal graft block RECOMMENDED SUTURES : RECOMMENDED SUTURES 4-0 to 6-0 braided sutures-temporarily attach the flieringa ring to limbus or sclera 7-0 to 8-0 nylon sutures –graft stabilization (8-16 simple interrupted sutures) 8-0 to 10-0 –simple continuous suture to supplement the interrupted sutures) PREPARATION OF DONOR CORNEA : PREPARATION OF DONOR CORNEA DONOR – should be free of infectious diseases Aseptically remove the globe – several drpos of neomycin,bacitracin,polymyxin-B Placed in sterile moist chamber-cornea upward(use within 7 days) Remove only cornea with 2mm of scleral rim(-20 degree – 18 months) cont………. : cont………. Prior to use epithelial & endothelial with descemet”s membrane surfaces are vigourously scraped leaving corneal stromal collagenous lamellae. PENETRATING KERTOPLASTY : PENETRATING KERTOPLASTY DEFINITION Affeted tissue removed full thickness(all layers of cornea) Replaced with donor button liner with viable endothelium TECHNIQUE : TECHNIQUE Lesion is removed with trephine set at 1mm depth. Trephine is withdrawn immediately on entering the anterior chamber Tissue tags trimmed from the incision edges with corneal scissors & fine forceps Donor button is washed with antibiotics cont…….. : cont…….. Cornea,5mm rim of sclera removed, epithelium is placed on teflon block & donor button is cut from the endothelial side with trephine Donor button is 0.5mm larger in dia than recipient bed to allow for shrinkage(endothelium must not be touched) cont………. : cont………. Donor button is removed & placed in the recipient bed with four cardinal sutures, one in each quadrant.Put interrupted or continuous sutures.After that cardinal sutures are removed. Anterior chamber then reconstituted with balanced salt solution & an air bubble POST OPERATIVE CARE : POST OPERATIVE CARE Topical antibiotics & corticosteroids- four times a day given - postoperatively Postoperative vascularization minimized by fine sutures(8-0 to 10-0 nylon) & corticosteroids(0.1 percent dexamethasone) Sutures removed after 12-18 days. cont,……… : cont,……… Hyaluronic acid & methycellulose in the anterior chamber & on the edges of corneal incision protects the corneal endothelium from surgical trauma. The material is irrigated from the eye after suturing. cont,…… : cont,…… Major problem -formation of protein rich plasmoid aqueous -shrinkage of the donor button -postoperative vascularization To minimize the formation of plasmoid aqueous : To minimize the formation of plasmoid aqueous -Systemic corticosteroids(oral prednisolone 1-2mg/kg daily for 3 days -Topical corticosteroids (dexamethasone 0.1 percent QID several days before surgery) -Topical antiprostaglandins (flurbiprofen or indomethacin) -Systemic antiprostaglandins (flunixin meglumine-1mg/kg I/v at induction -Acetyl salicylic acid-25mg/kg PO daily for 2 days before surgery) -Heparin & epinephrine (itraocular flushing solution) LAMELLAR KERATOPLASTY : LAMELLAR KERATOPLASTY DEFINITION Epithelium & superficial stroma are dissected free & replaced with donor tissue. TECHNIQUE : TECHNIQUE The area to be removed is outlined with a trephine set at 0.3mm Lesion removed with a corneal dissector & number 64 Beaver blade or scissors Donor eye – washed with antibiotic solution.The lamellar graft is removed from the donor eye with an electrokeratotome or a Martinez corneal dissector. cont……. : cont……. The graft is made 0.5mm larger than the recipient bed. The graft is sutured into the recipient bed with either a continuous suture with a burier knot or multiple interrupted sutures. Postoperatively topical antibiotics & corticosteroids are applied 4 times daily. AUTOGENOUS LAMELLAR CORNEAL TRASPLANTATION : AUTOGENOUS LAMELLAR CORNEAL TRASPLANTATION A square block of tissue is excised at the ulcer site for debridement & graft site preparation. A slightly larger graft is harvested by superficial keratectomy-on the same cornea or contralateral cornea. The graft is sutured into the recipient bed. It prevents the graft rejection, but vascularization of the site often occurs PENETRATING CORNEOSCLERAL ALLOGRAFT : PENETRATING CORNEOSCLERAL ALLOGRAFT Replacement of continuous cornea & sclera from adonor of the same species – treatment for canine epibulbar melanomas. Corneoscleral donor tissue is collected – as soon as possible before resection of the lesion & is kept on a sterile gauze pad moistened with balanced salt solution. cont……… : cont……… All traces of uveal tissues are removed from the graft to reduce the severity of postoperative immune reactions. The graft is sutured with 8-0 to 10-0 monofilament nylon. Eye is then treated with topical antibiotics & corticosteroids 4-6 times daily for 7-10 days. Slide 42: THANK YOU