This document discusses penetrating keratoplasty (PK), which is a surgical procedure where diseased corneal tissue is replaced with healthy donor corneal tissue. It describes the different types of keratoplasty, indications for surgery, donor selection criteria, surgical procedure details, postoperative care, and expected outcomes. PK aims to restore vision, integrity of the eye, eradicate disease, and improve appearance by replacing opaque corneal tissue with clear donor tissue.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Pseudophakic bullous keratopathy (PBK) is a post-operative condition that can occur as a complication of cataract extraction surgery and intraocular lens placement.
May be manifest in the immediate post-operative period or symptoms may not present for many years.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Pseudophakic bullous keratopathy (PBK) is a post-operative condition that can occur as a complication of cataract extraction surgery and intraocular lens placement.
May be manifest in the immediate post-operative period or symptoms may not present for many years.
This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
Indication, contraindication, advantage, disadvantage, types of keratoplasty, complication of keratoplasty and management, corneal graft rejection and failure
M.S ophthalmology, sarojini devi eye hospital, regional institute of ophthalmology, osmania medical college, hyderabad, telangana
This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
Indication, contraindication, advantage, disadvantage, types of keratoplasty, complication of keratoplasty and management, corneal graft rejection and failure
M.S ophthalmology, sarojini devi eye hospital, regional institute of ophthalmology, osmania medical college, hyderabad, telangana
LASIK or Lasik (laser-assisted in situ keratomileusis), commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and an actual cure for astigmatism, since it is in the cornea. LASIK surgery is performed by an ophthalmologist who uses a laser or microkeratome to reshape the eye's cornea in order to improve visual acuity. For most people, LASIK provides a long-lasting alternative to eyeglasses or contact lenses.
The planning and analysis of corneal reshaping techniques such as LASIK have been standardized by the American National Standards Institute, an approach based on the Alpins method of astigmatism analysis. The FDA website on LASIK states,
"Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so."
The procedure involves creating a thin flap on the eye, folding it to enable remodeling of the tissue beneath with a laser and repositioning the flap.
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Acetabularia Information For Class 9 .docxvaibhavrinwa19
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
6. CONTRAINDICATIONS
• Advanced Dry eye
• Anterior staphyloma
• Severe cases of SJ syndrome
• Grade 4 chemical burns
• Ocular cicatrical pemphigoid
RELATIVE C/I
• Multiple graft failure
• RD with PR inaccurate
• severely scarred cornea with AS trauma/infection in
1 eye with other eye 6/6
• central corneal opacity with peripheral clear area
7. DONOR SELECTION
• CONTRA INDICATIONS
• prion d/s :Jacob - Creutzfeld syndrome
: PPLE
• infections : AIDS,Septicemia,Syphilis,Viral hepatitis
• malignancy :HL,PCV,leukemia,lymphoma,myeloma
• intrinsic eye d/s :KC,KG
• intra ocular sx : LASIK,PRK,RK
• death of unknown cause
8. • H/O & EXAMINATION
• MEDICAL H/O
– cause of death
– past medical h/o
– time of death
– donor identification details
– lab reports
• SEROLOGY TESTING
– HIV,HBAg,HEP C +/- syphilis
• ENUCLEATION,INSITU EXCISION,CORNEOSCLERAL
RIM SECTIONING
9. EVALUATION OF DONOR CORNEA
• Gross insitu examination
– Intactness of globe
• Slit Lamp Examination
– Shape and size of cornea
– Epithelial haze ,defects,Abrasions
– Any Stromal opacities ,oedema
– Microcystic oedema
– Descemet’s fold /Breaks
– Condition of anterior chamber
10. • ENDOTHELIAL MICROSCOPY
– critical count :300 -500 cells/mm²
– eye bank cut off:1500-2200 cells/mm²
– r/o polymegatheism,pleomorphism,guttae
– r/o inflammatory cells,bacteria
• SPECULAR MICROSCOPY
- usually after placement in storage media in room temp
- cell density,size,uniformity of size of cell
• LIGHT MICROSCOPY
– phase contrast /transmitted light microscopy + intra vital
staining of endothelial layer by trypan blue.
– evaluates after storage & close to time of transplantation
11.
12.
13.
14. RECRUITMENT OF DONOR TISSUE
• tissue removed within 6 hours after death.
• Cornea can be stored in :
• SHORT TERM (UPTO 96 HOURS)
– Whole Globe preserved in moist chamber(48hrs
– McCarey-Kaufman media
• INTERMEDIATE TERM (UPTO 2 WKS)
– Optisol/Dexsol/Ksol Corneal storage
• ORGAN CULTURE (UPTO 35 DAYS)
• LONG TERM (UPTO 1 YEARS)
– cryopreservation
15. PROCEDURE FOR PK
• Preoperative preparation
• Anesthesia
• Surgical preparation
• Trephination of Donor cornea
• Trephination of Recipient cornea
• Suturing of Donor cornea
• Post operative treatment
16. PREOPERATIVE EVALUATION OF
RECIPIENT
• Ocular history
• General history
• Visual acuity
• Gross ocular examination
• Slit lamp biomicroscopy
– conjunctiva & cornea
– AC & iris
– lens
• Intraocular pressure
• Fundus evaluation
23. TREPHINATION OF RECIPIENT CORNEA
• Marking centration on host cornea
• Trephination done either by hand held, suction &
automated trephines
24.
25. DIFFERENT TYPES OF FLAPS
• Top Hat Shape -Provides large endothelial surface
transplantation
• zig-zag shape- Hermetic wound seal Angled edge
provides smooth transition between host and
donor
• Mushroom Shape- Preserves host endothelium
26. SUTURING OF DONOR CORNEA
• AC formed - viscoelastic
• 10-O nylon & 11-0 mersilene.
• Cardinal sutures - 4 in number
– 1st suture :12 o’ Clock
– 2nd suture : 6 o’ clock
– 3rd & 4th :90 ⁰ to 1st & 2nd
• Suture depth : 90%
• Equidistant bites
– 16 interrupted//20-24 single running
• Bury knots on donor side /recipient cornea.
• Check wound leak. -
27.
28. TYPE OF SUTURING
• interrupted
• combined interrupted & continuous
• single continuous sutures
• double continuous sutures
29. NO ROTATIONAL EFFECT. CLOCKWISE ROTATION OF
GRAFT BY 0.7+/- 1MM //11⁰
BITES FORM ISOSCELES TRIANGLE
• COUNTER CLOCKWISE ROTATION
OF GRAFT 0.7+/- 1MM//11⁰
30.
31.
32. INTRA OP REGIME
• Subconjunctival injections of gentamycin ( 40mg in 1
ml ) + dexamethasone ( 4 mg in 1 ml)
• Pad & bandage for 24 hrs.
POST OP REGIME
• Assess Visual acuity
• Degree of pain ,Wound leak, pupil shape, corneal
epithelial status, anterior chamber, IOP, early signs of
infection & endophalmitis
• Medication:- Topical antibiotics & steroids +
Lubricants + cycloplegic.
