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)
COMMENTS