Enucleation with csr training ppt in saloon hospital pune By dnyaneshwar bhagwan potfode

1. ENUCLEATION

2. Enucleation
• Removal of the globe and contents
• Preserve other periorbital structures
• Apart from donation in cadavers, other indications:
• Painful blind eye
• Staphyloma
• Phthisis bulbi
• Malignancies
• Sympathetic ophthalmia

3. Procedure
Asepsis
• Painting and draping done following aseptic precautions
• Eye speculum applied and globe inspected
Peritomy
• 360 degree peritomy is done using peritomy scissors
• Sub Tenons space dissected and plane created
EOM
• Extraocular muscles identified, held with muscle hook
• Tied and cut near insertion using tenectomy scissors
• Medial or lateral rectus held with clamp as support before cutting

4. Optic nerve
• Eyeball now freely mobile, prolapsed out
• Optic nerve identified and held using optic nerve guide
• Enucleation scissors passed along medial wall, nerve cut leaving 5-10mm stump
Removal
• Remaining adherent structures cut
• Eyeball removed
Packing
• Orbital cavity packed with cotton or wet pack
• Remnant conjunctiva and eyelids may be sutured

5. Instruments

6. Storage of eyeball
• Sterile glass jar
• Eyeball held in a metal cage
• Surround with cotton or gauze to protect
• Pour about 5ml of antibiotic or balanced salt solution to wet the
eyeball and gauze

7. CORNEO-SCLERAL RIM
EXCISION

8. CSR Excision
• The cadaveric cornea with a rim of sclera is excised
• To be used for corneal transplantation
• Essential to collect approx. 5 ml blood sample for serology testing
• Criteria to choose donor
• Non infective cause of death
• Cornea clear
• Serology negative
• Patient relatives’ consent

9. Procedure
Aspesis
• Painting with betadine solution and draping done
• Eye speculum applied, cornea washed with normal saline
Peritomy
• 360 degree conjunctival peritomy done
• Cuts given on the conjunctiva at 4 sites to expose more area
• Scrape remaining conjunctiva from limbus using blade
Scleral
incision
• Incision made with 15 no. blade 4mm from limbus parallel to it
• Extend this incision using curved corneal scissors all around cornea maintaining 4mm
margin

10. Caution!
• Scissors shouldn’t be visible in AC
• Vitreous should not gush out
• Do not handle cornea with instruments/ produce corneal folds
CSR
• Ensure the tissue is completely cut
• Hold the scleral rim with forceps, lift slightly and separate the uveal tissue by pulling
downwards
• Complete the separation by changing your grip position, do not pull the cornea
Storage
• Once separated, transfer the CSR to storage medium
• Place the rim with outer corneal surface facing the bottom of the bottle
• Place eye shells over the donor eye and close and clean lids

11. Instruments
Peritomy scissors Lims forceps 15 number blade Right and left
curved corneal
scissors
Iris dissector
Storage medium Eye shells

12. Storage of corneal tissue
• Must be refrigerated in cold chain
• Short term: 2 days
• Moist chamber
• M-K media
• Intermediate term: upto 2 weeks
• Dexsol
• Optisol
• Commonly used: Cornisol- sterile, 20 ml buffered corneal preservation medium
supplemented with chondroitin sulfate (Membrane stabilizer), recombinant human insulin
(Metabolism enhancer), Dextran (Osmotic agent), stabilized L-glutamine, ATP precursors,
vitamins, trace elements, gentamicin, streptomycin and pH indicator.
• Long term
• Organ culture
• Cryopreservation

13. CONSENT FORMS
Enucleation
EYE DEPARTMENT
Sassoon General Hospital, Pune, Maharashtra
(In the compound of Sassoon General Hospital, Pune)
CONSENT TO REMOVE EYES
I, being the next of kin of Shri. / Smt./ Kum.
________________________________________________________________.
Or the one in charge of his/her body, do hereby consent to the enucleation
(Removal) of his/her eyes to be used by the eye department, Sassoon General
Hospital, Pune (Tel. No. 020-2612 8000; Ext. 207 and Eye Ward Ext. 274) to
restore the sight of some blind person and/or for research seeking ways to
prevent blindness and to find cause for diseases of the eye.
Witness: Relative/Friend/Family Doctor
1. Name ______________________________________________________
Full Address
Signature
Relationship
2. Name ______________________________________________________
Full Address
Signature
Relationship

14. CONSENT FORMS
Corneo-scleral rim
excsion

15. ENUCLEATION

16. CSR EXCISION