Corneal transplantation has evolved significantly since the first attempts in the early 1800s. Today, it is one of the most common and successful organ transplant procedures. The document traces the key developments in corneal grafting surgery, from the first suggestions of replacing opaque corneas to modern techniques like Descemet's membrane endothelial keratoplasty. It provides details on procedures like penetrating keratoplasty and deep anterior lamellar keratoplasty, including indications, surgical steps, potential complications, and post-operative management. The success of corneal transplantation techniques has expanded treatment options for corneal diseases and visual rehabilitation.
TONOMETRY • Tonometry is the procedure performed to determine the intraocular pressure (IOP).
3. CLASSIFICATION TONOMETRY DIRECT INDIRECT Indentation Applanation Manometer
4. APPLANATION Contact Non-contact Goldmann Perkins Air-puff Pulse air
5. INDENTATION TONOMETER • It is based on fundamental fact that plunger will indent a soft eye more than hard eye. • The indentation tonometer in current use is that of Schiotz . • It was devised in 1905 and continued to refine it through 1927.
6. PROCEDURE • Patient should be anaesthetising with 4% lignocaine or 0.5% proparacaine. • with the patient in supine position, looking up at a fixation target while examiners separates the lids and lower the tonometer plate to rest on the cornea so that plunger is free to move. •
About awareness of eye donation. Author is assistant professor in Ayurvedic Ophthalmology MES Ayurved Mahavidyalaya and consulting ayurvedic ophthalmologist at Shree Vyankatesh Netralay Chiplun.
TONOMETRY • Tonometry is the procedure performed to determine the intraocular pressure (IOP).
3. CLASSIFICATION TONOMETRY DIRECT INDIRECT Indentation Applanation Manometer
4. APPLANATION Contact Non-contact Goldmann Perkins Air-puff Pulse air
5. INDENTATION TONOMETER • It is based on fundamental fact that plunger will indent a soft eye more than hard eye. • The indentation tonometer in current use is that of Schiotz . • It was devised in 1905 and continued to refine it through 1927.
6. PROCEDURE • Patient should be anaesthetising with 4% lignocaine or 0.5% proparacaine. • with the patient in supine position, looking up at a fixation target while examiners separates the lids and lower the tonometer plate to rest on the cornea so that plunger is free to move. •
About awareness of eye donation. Author is assistant professor in Ayurvedic Ophthalmology MES Ayurved Mahavidyalaya and consulting ayurvedic ophthalmologist at Shree Vyankatesh Netralay Chiplun.
Enucleation and evisceration. ophthalmology
contains the two methods of eye ball removal, with indications, surgery, complications, treatment, etc
its has animated clips and picture
wonderful slide i have prepaired
can be used for clinical as well as educational purpose
Enucleation and evisceration. ophthalmology
contains the two methods of eye ball removal, with indications, surgery, complications, treatment, etc
its has animated clips and picture
wonderful slide i have prepaired
can be used for clinical as well as educational purpose
Iridodialysis repair with modified double armed closed chamber techniqueRidho Ranovian
To elaborate the modified closed-chamber technique with ICCE in managing subtotal iridodialysis with traumatic cataract due to contusion ocular trauma.
A cataract is a clouding or opacity that
develops in the crystalline lens of the eye or in its envelope, varying in degree from slight opacity to obstructing the passage of light.
Progressive, painless clouding of the natural, internal lens of the eye.
Principles and technique of pneumatic retinopexy (Dr. Avuru C.J).pptxAVURUCHUKWUNALUJAMES1
Retinal detachment surgeries, principles and technique of pneumatic retinopexy, current trend in retinal detachment surgeries, development of skills in binocular indirect ophthalmoscopic examination, residency traning presentation, University college hospital Ibadan, Oyo state Nigeria, Vitreo-retinal subspecialty training, West african college of surgeons, federal teaching hospital, Lokoja, Kogi state, Nigeria.
Retinal vein occlusion (RVO) is an obstruction of the retinal venous system by thrombus formation and may involve the central, hemi-central or branch retinal vein.
The most common aetiological factor is compression by adjacent atherosclerotic retinal arteries.
Other possible causes are external compression or disease of the vein wall e.g. vasculitis.
Photodynamic Therapy (PDT)
Therapeutic procedure
Utilizes the photosensitive intravenous drug, verteporfin (Visudyne)
With a low power, long duration infrared laser
In ophthalmology it is used to treat
Neovascular age related macular degeneration (AMD)
Polypoidal choroidal vasculopathy (PCV)
Haemangioma
Central serus retinopathy(CSR)
Retinopathy of prematurity (ROP), initially described as retrolental fibroplasia one of the leading cause of blindness in children.
Despite advances in diagnosis and treatment, as medicine and technology advances and premature infants are surviving at earlier gestational ages, ROP continues to be a significant problem.
ROP results in disorganized growth of retinal blood vessels, which may lead to scarring and retinal detachment.
“An ENT disease with an ophthalmic manifestation”
Orbital cellulitis (OC) is an inflammatory process that involves the tissues located posterior to the orbital septum within the bony orbit, but the term generally is used to describe infectious inflammation.
It manifests with erythema and edema of the eyelids, vision loss, fever, headache, proptosis, chemosis, and diplopia.
OC usually originates from sinus infection, infection of the eyelids or face, and even hematogenous spread from distant locations.
OC is an uncommon condition that can affect all age groups but is more frequent in the pediatric population.
Exudative retinal detachment develops when fluid collects in the subretinal space.
The subretinal space between the photoreceptors and the retinal pigment epithelium is the remnant of the embryonic optic vesicle.
In the developed eye the subretinal space is of minimal size, but it can reopen under pathological conditions that disrupt the integrity of blood-retinal barrier.
Inflammatory, infectious, infiltrative, neoplastic, vascular, and degenerative conditions may be associated with blood-retinal barrier breakdown and the sequential development of exudative retinal detachment.
This elaborate on the pathogenesis and the differential diagnosis of exudative retinal detachment and specifically discuss the spectrum of diseases associated with exudative retinal detachment in uveitis clinics.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Evolution of Corneal Grafting Surgery
• Corneal transplantation refers to surgical
replacement of a full-thickness host
cornea(penetrating keratoplasty [PK]) or lamellar
portion of the host cornea with that of a donor
cornea.
• Today, the keratoplasty is considered as the most
frequently performed and the most successful
organ transplantation technique worldwide.
• The success of this procedure has not been
an overnight event.
3. • 1813 K Himly- Suggested replacing opaque cornea in
one animal with clear cornea from another animal.
• 1824 F Reisinger -Suggested replacing opaque human
cornea with clear animal cornea- Coined the term
• 1906 Edward Konrad Zirm-Reported first successful
penetrating keratoplasty in a human
• 1910-1950 VP Filatov -Father of keratoplasty
Performed systematic study of keratoplasty
Suggested using cadaver corneas as donor tissues
Devised numerous instruments
4. • 1974 B McCarey and H Kaufman -Developed
Corneal Storage Media
• 1985 Archila EA -DALK with air assisted dissection
• 1998 Melles GR -Deep anterior lamellar
keratoplasty
• 2006 Price and Gorovoy- Descemet’s stripping
endothelial keratoplasty (DSEK) and Descemet’s
stripping automated endothelial keratoplasty
(DSAEK)
• 2006 Melles GR Descemet’s membrane
endothelial keratoplasty (DMEK)
5. • Ongoing innovations in lamellar transplantation have
produced a virtual alphabet soup of nomenclature to
describe the various approaches.
7. Indications for PKP
1. Optical-
The keratoplasty is performed with the main purpose of
improving the visual acuity. This is the most common indication
of penetrating keratoplasty and comprises more than 90 percent
of the total penetrating keratoplasties performed in majority of
the countries.
• Bullous keratopathy
• Keratoconus
• Corneal dystrophy
• Corneal inflammatory diseases —
interstitial keratitis, HSV
• Corneal traumatic scars
• Failed grafts
8. 2. Tectonic- The prime purpose of tectonic/reconstructive
keratoplasty is to restore the altered corneal structure. Although
improved visual acuity remains a relevant consideration,
restoration or at least preservation of ocular anatomy and
physiology are the principal indications for tectonic corneal
grafts
• Corneal perforation
• Peripheral corneal thinning
9. 3. Therapeutic- Therapeutic keratoplasty is mainly
indicated in cases of infectious keratitis to eliminate the
infectious load in eyes with keratitis unresponsive to specific
antimicrobial therapy
• Infective keratitis
10. How do You Grade Corneal Graft Prognosis According to Disease
Categories?
Brightbill’s Classification
14. Keratoplasty and Eye Banking
Contraindications for Cornea Donation
1. Systemic diseases
• Death from unknown cause
• CNS diseases of unknown cause
• Creutzfeldt–Jakob disease, CMV encephalitis, slow virus
diseases
• Infections:
• Congenital rubella, rabies, hepatitis, AIDS, Syphilis
• Septicemia
• Malignancies
• Leukemias, lymphomas, disseminated cancer
15. 2. Ocular diseases
• Intraocular surgery
• History of glaucoma and iritis
• Intraocular tumors
3. Age
• < 1 year old
• Corneas are difficult to handle
• Small diameter; friable
• Very steep cornea (average K = 50D)
• > 75 years
• Low endothelial cell count
4. Duration of death > 6 hours(Can go up to 24hrs AAO)
5. Severe hemodilution: Affects accuracy of serological testing
16. How is the Donor Corneal Button
Stored?
Storage Media
1. Short term (days)
•Moist chamber:
• Humidity 100%
• Temp 4°C
• Storage duration: 48 hours
• McCarey-Kaufman medium:
• Standard tissue culture medium (TC199, 5% dextran,
antibiotics)
• Temp 4°C
• Storage duration: 2–4 days
18. 3. Long term (months)
• Cryopreservation:
• Liquid nitrogen
• Temp -196°C
• Storage duration: 1 year
• Disadvantages: Expensive and unpredictable results; usually
not suitable for optical grafts
22. Steps in PKP
1. Preoperative preparation
• GA Preferble
• Maumenee/Wire/Screw speculum
• Flieringa ring if necessary
(indications: Post vitrectomy, aphakia,trauma, children)
Measure the recipient graft size with a caliper
“How do you check the corneoscleral disc?”
• Container (name, date of harvest, etc.)
• Media (clarity and color)
• Corneal button (clarity, thickness, irregularity,surface damage)
Grade A+ or A depending on the indication
Endothelial cell count >2000/mm3
23. 2. Donor button
• Check corneoscleral disc
• Harvest donor cornea
button with Weck trephine on
Troutman punch:
• Approach from posterior
endothelial side
• Use trephine size 0.25–0.5
mm larger than recipient bed
• Keep button moist with
viscoelastic
• Because donor button is punched from
posterior endothelial surface
• Tighter wound seal for graft
• Increases convexity of button (less
peripheral anterior synechiae postop)
• More endothelial cells with larger button
“Why is the donor button made larger than
the recipient bed?”
24. 3. Recipient bed
• 3-point fixation (two from bridle suture, one
with forceps)
• Weck trephine imprint to check size and
centration
• Other types of trephine:
Baron Hessburg trephine and Hanna trephine
(suction mechanism)
• Set trephine to 0.4 mm depth
25. • Enter into AC with blade
• Complete incision with corneal
scissors
• Fill AC with viscoelastic
26. 4. Fixation of graft
• Place donor button on recipient bed
• Four cardinal sutures with 10/0 nylon (at 12 o’clock first,
followed by 6,3 and then 9)
• 16 interrupted sutures
Advantages of interrupted sutures:
• Easier for beginners
• Better for inflamed eyes and
eyes with vascularization
• Better for pediatric
patients/active infections
• Suture manipulation can be
done
27. SUTURING TECHNIQUES IN PKP
Single Interrupted Suturing Technique
Single Continuous Suturing Technique
Double Continuous Suturing Technique
Combined Continuous and Interrupted Suturing (CCIS)
Technique
Continuous suture:
• Faster
• Better astigmatism control
• Not for cases where selective suture removal may be needed
(e.g.infections)
• A single continuous suture is technically more difficult than interrupted sutures,
because one irregular bite can impair the integrity of the closure and cannot be
removed without removing the entire suture. The four cardinal sutures are placed
in the regular manner followed by a 24 bite continuous suture with 10-0 nylon
with a 95 percent depth.
28. Single Continuous Suturing Technique
– There are 3 types of single continuous suturing
techniques namely, torque, anti torque and no torque
.
– The torque pattern rotates the corneal graft
counterclockwise by 0.7 +/- 0.1 mm at the wound or
11 degrees;
– the anti torque pattern rotates the corneal graft
clockwise by 0.7 +/- 0.1 mm at the wound or 11
degrees;
– the no torque pattern, the bites of which form an
isosceles triangle, produces no rotational effect.
29. 5. End of operation
• Check water tightness
• Check astigmatism with keratometer
• Intra cameral Moxifloxacine
• Subconjunctival steroids/antibiotics
• BCL
33. What are the Causes of Graft Failure?
1. Early failure (< 72 hours):
• Primary donor cornea failure
• Unrecognised ocular disease
• Low endothelial cell count
• Storage problems
• Surgical and postoperative trauma:
• Handing
• Trephination
• Intraoperative damage
• Recurrence of disease process (e.g. infective keratitis)
• Others:
• Glaucoma
• Infective keratitis
2. Late failure (> 72 hours):
• Rejection (30% of late graft failures)
• Glaucoma
• Persistent epithelial defect
• Infective keratitis
• Recurrence of disease process
• Late endothelial failure
34. Post Op Management PKP
• Topical antibiotics
• Topical steroids
• IOP control
• Regular follow-up and detect and treat
complications
• Suture management
37. Introduction to DALK
• Deep anterior lamellar keratoplasty: In this
type of keratoplasty the host dissection is
done up to the level of the Descemet’s
membrane and a full thickness graft which is
devoid of endothelium is sutured with 10-0
monofilamemt to the host.
38. Indications for DALK
1.Optical
• Reis-Bücklers dystrophy
• Salzmann’s nodular dystrophy
• Keratoconus
• Granular dystrophy
• Band shaped keratopathy
• Spheroidal degeneration
• Trachomatous keratopathy
• Superficial scars secondary to
infections and trauma
• Superficial corneal opacification
caused by keratorefractive
surgeries
• Hurler’s syndrome
41. DALK vs PKP
Advantages
• Extraocular procedure
• Less potential for intraocular complications
• Less astigmatism
• Less chances of graft rejection
• Donor quality criteria less stringent
• Does not preclude a future penetrating keratoplasty.
Disadvantages
• Technically difficult
• Interface scarring
• Epithelial defects
• Less than optimal visual results.
42. Steps in DALK
• Main requirements other than in PKP
– Corneal topography
– Corneal pachymetry- detect the thickness of cornea and to get a idea
of the depth of initial trephination
– Anterior segment OCT- detect the depth of corneal scar, important in
deciding the technique of stromal dissection
– Donor corneal stroma and epithelium should be healthy and not
depend on endothelial cell count because it is removed.
– Need a backup cornea ready if convection to PKP is required
43. Steps in DALK
• Prepare donor cornea, keep in optisol
• Surgery usually under GA
• Patient corneal markings
• Trephination of desired thickness with Barren suction trephine, 2/3
thickness
• Dissection of superficial lamella
• Anwar’s big bubble
• Parasentesis, insert air bubble in to AC, confirm big bubble
• Brave slash
• Replace the air with viscoelastic
• Cut the deep stromal tissue
• Washout the viscoelastic thoroughly
• Remove the donor corneal endothelium
• Keep it on the recipient bed
• Suture the graft with 16 interrupted 10 0 nylon
• BCL
44. • If there is deep cornel scar, big bubble
technique cannot be performed
• After superficial lamella is removed , manual
dissection of stroma up to the Descemets
membrane should be done
• Donor cornea and recipient size is similar
47. SUTURE REMOVAL
• Interrupted sutures should be removed as soon
as the vessels bridge the host-graft junction or at
6 months postoperatively in a non-vascularized
cornea.
• Suture removal may be undertaken earlier for any
suture related problems such as loose sutures,
broken sutures and suture abscesses.
• Selective suture removal may be done for the
control of postkeratoplasty astigmatism
beginning from 1st month onwards.
49. Types of EK
• Descemet’s Stripping Endothelial Keratoplasty
(DSEK/DSAEK)
• Descemet’s membrane endothelial keratoplasty (DMEK)
50. Descemet’s stripping endothelial
keratoplasty (DSEK),
• In Descemet’s stripping endothelial keratoplasty (DSEK), the
patient’s Descemet membrane is peeled off, using specially
designed strippers and replaced with a partial thickness graft:
a transplanted disc of Posterior Stroma, Descemet and
Endothelium (20-30 % of the inner donor cornea).
• Both donor and host cornea are manually dissected.
• Differently, in Descemet’s stripping automated endothelial
keratoplasty (DSAEK) the donor dissection is carried out using
a mechanical microkeratome. DSAEK is described as the
procedure of choice for corneal endothelial failure in many
centers
53. Advantages of EK over PKP
• Rapid visual rehabilitation
• No suture-related problems
• No induced Astigmatism
• Tectonic stability
• Normal corneal sensitivity post op
• No ocular surface problems
• Fewer rejections
• Small incision with less risk of SCH