Table of Contents
Corneal Transplant
Ali Gage is a 28 y/o S/P LASIK OD with
20/15 vision Keratoconus OS 20/800 vision best corrected OS to 20/50
(HCL) contact lens intolerant.
Surgeon’s initial view through the
microscope.
Corneal shield is placed on the patient’s
cornea while the donor cornea is being prepared.
The corneal trephine is a round cutting
blade, acting like a “cookie cutter”.
The trephine is slowly rotated back
and forth until the patient’s cornea is totally cut through.
Completed trephination
A thick gel-like material (viscoadherent
(Ocucoat)) is injected to maintain the normal curvature of the eye during
surgery
Completed trephination.
It helps to visualize the movement
of the clear viscoadherent under the cornea throughout the surgery when
an air bubble is within the fluid.
Air bubble movement.
More viscoadherent (Healon GV) being
injected.
The uncut portions of the patient’s
cornea are cut using a Superblade (ultra-sharp razor-like blade).
Injecting viscoadherent
The patient’s cornea wrinkles easily
because keratoconus corneas are very thin.
The last cut to be made in order to
remove the patient’s cornea.
Superblade Close-up
Patient’s cornea completely removed
More viscoadherent must be placed over
iris in preparation for the donor cornea.
The viscoadherent is so viscuous that
it forms mounds rather than flattening out.
Nice delicate bed of viscoadherent
is ready for the donor cornea.
The pink color of the donor cornea
comes from preservative used prior to transplantation.
The donor cornea is lifted off the
cutting block with a highly polished spatula
Cornea Underside
The donor cornea needs to be flipped
over into place. It is very crucial not to touch the underside of the
donor cornea.
Donor cornea flipped into place.
Closed forceps used to nudge the donor
into place.
Closed forceps used to nudge the donor
into place.
Donor cornea is now in place. The air
bubble assures an adequate space between the donor cornea and the patient’s
iris.
Four stay sutures will be placed at
the 12, 3, 6, and 9 o’clock position to secure the cornea in place during
the final suturing.
12 o’clock stay suture in place and
starting the 6 o’clock stay suture
Needle in place at the 6 o’clock position.
3 o’clock stay suture being placed.
The last of 4 stay sutures being placed.
Viscoadherent must be injected whenever
the gel expresses out.
The ultra-sharp superblade is used
to cut the extra suture after the knot is tied.
Excess suture can also be cut with
micro-scissors.
A new 10-nylon suture is now used that
has a needle on both ends of the suture. Two needles are needed in case
the other becomes dull.
The needle is first passed through
the donor cornea and then through the patient’s cornea.
After the needle is through the cornea
the end is grasped, the utmost care is taken not to touch the tip of
the needle.
After the first needle pass is complete,
the second is made one clock hour away.
The looping suture is easily seen before
it is pulled tight.
When suturing the cornea, the surgeon
must be able to use the other hand equally well (ambidextrous).
The suturing is continued around the
graft.
The surgeon must also be able to place
a suture back-handed as well.
Placing the last pass of the running
suture.
At this point the last of the running
suture has been placed.
The looping suture is now pulled tight
all away around.
Tightening the suture continues all
the way around.
Scissors are used to cut the 4 stay
sutures. If the running suture is inadvertently cut, the suturing process
must be
The last stay suture is being cut.
The running suture is pulled tight
one last time before tying the knot.
More viscoadherent is injected to maintain
the separation between the graft and the iris.
The second loop of the knot is tied
on the running suture.
The third loop of the knot is now tied.
The last knot loop is tied.
The fifth and last knot loop is tied.
Close-up of the final knot of the running
suture.
The ends of the suture are cut.
Close-up of the final and only knot
tied to secure the running suture.
The running suture is now rotated in
order to pull the knot within the tissue to eliminate irritation to
the patient.
Rotation of the running suture is continued
until enough slack is present to allow the knot to be pulled into the
tissue.
The knot is now being rotated into
the tissue.
Suturing Close-up
An absorbable contact lens is hydrated
with antibiotic and placed over the new graft.
Collagen shield contact lens being
positioned over the graft.
Collagen shield in place.
Collagen shield in place.
Needle used to inject steroid to prevent
graft rejection.
Steroid close-up
A cannula is used to irrigate away
the excess injected solution.
Extra steroid is placed on the collagen
shield contact lens.
Irrigating away the excess solution.
Irrigating away the excess solution.
Removing the lid retractor.
Removing the lid retractor.
Thank you for visiting ZdenekEye.com
We hope you enjoyed the slide show.
|