Eye: Corneal Surgeries, Keratoplasty

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CORNEAL SURGERIES
  • Phototherapeutic keratectomy (PTK)
  • Keratoplasty
  • Phototherapeutic Kcratectomy
  • PTK is a laser procedure that is used to treat diseased corneal tissue by removing or reducing corneal opacities and smoothing the anterior corneal surface to improve functional vision.
  • PTK is a safer, more effective (when indicated) alternative than penetrating or lamellar  keratoplasty.
Contraindication- in patients with active herpetic keratitis because the ultraviolet rays may reactivate latent virus.
Side effects- induced hyperopia and stromal haze.
Complications -delayed re-epithelialization (particularly in patients with diabetes) and bacterial keratitis.
 Postoperative management
  • Re-epithelialization is promoted with a pressure patch or therapeutic soft contact lens.
  • Antibiotic and corticosteroid ointment
  • NSAIDs
  • Follow-up examinations are required for up to 2 years.

Keratoplasty
  • Keratoplasty (ie, corneal transplantation or corneal grafting) involves replacing abnormal host tissue with a healthy donor corneal tissue.
  • Indications
    • Keratoconus
    • Corneal dystrophy
    • Corneal scarring from herpes simplex keratitis
    • Chemical bums
Procedure
  • The surgeon determines the graft size before the procedure, and the appropriate size is marked on the surface of the cornea.
  • The surgeon prepares the donor cornea and the recipient bed, removes the diseased   cornea, places the donor cornea on the recipient bed, and sutures it in place.   
  • Sutures remain in place for 12 to 18 months.  
Potential complications
  • Early graft failure due to poor quality of donor tissue, surgical trauma, acute infection.
      • Persistently increased IOP
  • Late graft failure due to rejection  
Postoperative management
  • Mydriatic medications (2 weeks)
  • Topical corticosteroids (12 months; daily doses for 6 months and tapered doses thereafter)




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notes.nursium.com: Eye: Corneal Surgeries, Keratoplasty
Eye: Corneal Surgeries, Keratoplasty
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http://notes.nursium.com/2017/06/eye-corneal-surgeries-keratoplasty.html
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