This document summarizes various early and delayed postoperative complications that can occur following penetrating keratoplasty (corneal transplant surgery) and their management. Early complications discussed include suture-related problems, wound leaks, epithelial defects, inflammation, iris incarceration, graft failure, glaucoma, and infections. Delayed complications mentioned are graft rejection, infectious crystalline keratopathy, corneal membranes, cataract formation, and recurrence of the original corneal disease. Treatment approaches for each complication are also provided.
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
Corneal graft failure and rejection are the nightmares for an Ophthalmologist. Here is an overview on Rejection vs Failure, identification of risk factors, prevention and Mx of a failure
Corneal graft failure and rejection are the nightmares for an Ophthalmologist. Here is an overview on Rejection vs Failure, identification of risk factors, prevention and Mx of a failure
this slide share admixed with pictures and animations will give an overall idea of immunological disorders of cornea. it covers anatomy immunology, and pharmacology as well
fungal / mycotic corneal ulcer power point presentation for O.A 2nd year stud...Vinitkumar MJ
Belong suborder Acanthopodina and the genus Acanthamoeba
• Family of free-living cyst-forming protozoans that are ubiquitous in air, soil, dust and water.
• 11 species of which A. Castellanii and A. polyphaga are the most common in keratitis
• Life cycle consist of motile trophozoite and cyst dormant stage
Slide 1: Title Slide
Extrachromosomal Inheritance
Slide 2: Introduction to Extrachromosomal Inheritance
Definition: Extrachromosomal inheritance refers to the transmission of genetic material that is not found within the nucleus.
Key Components: Involves genes located in mitochondria, chloroplasts, and plasmids.
Slide 3: Mitochondrial Inheritance
Mitochondria: Organelles responsible for energy production.
Mitochondrial DNA (mtDNA): Circular DNA molecule found in mitochondria.
Inheritance Pattern: Maternally inherited, meaning it is passed from mothers to all their offspring.
Diseases: Examples include Leber’s hereditary optic neuropathy (LHON) and mitochondrial myopathy.
Slide 4: Chloroplast Inheritance
Chloroplasts: Organelles responsible for photosynthesis in plants.
Chloroplast DNA (cpDNA): Circular DNA molecule found in chloroplasts.
Inheritance Pattern: Often maternally inherited in most plants, but can vary in some species.
Examples: Variegation in plants, where leaf color patterns are determined by chloroplast DNA.
Slide 5: Plasmid Inheritance
Plasmids: Small, circular DNA molecules found in bacteria and some eukaryotes.
Features: Can carry antibiotic resistance genes and can be transferred between cells through processes like conjugation.
Significance: Important in biotechnology for gene cloning and genetic engineering.
Slide 6: Mechanisms of Extrachromosomal Inheritance
Non-Mendelian Patterns: Do not follow Mendel’s laws of inheritance.
Cytoplasmic Segregation: During cell division, organelles like mitochondria and chloroplasts are randomly distributed to daughter cells.
Heteroplasmy: Presence of more than one type of organellar genome within a cell, leading to variation in expression.
Slide 7: Examples of Extrachromosomal Inheritance
Four O’clock Plant (Mirabilis jalapa): Shows variegated leaves due to different cpDNA in leaf cells.
Petite Mutants in Yeast: Result from mutations in mitochondrial DNA affecting respiration.
Slide 8: Importance of Extrachromosomal Inheritance
Evolution: Provides insight into the evolution of eukaryotic cells.
Medicine: Understanding mitochondrial inheritance helps in diagnosing and treating mitochondrial diseases.
Agriculture: Chloroplast inheritance can be used in plant breeding and genetic modification.
Slide 9: Recent Research and Advances
Gene Editing: Techniques like CRISPR-Cas9 are being used to edit mitochondrial and chloroplast DNA.
Therapies: Development of mitochondrial replacement therapy (MRT) for preventing mitochondrial diseases.
Slide 10: Conclusion
Summary: Extrachromosomal inheritance involves the transmission of genetic material outside the nucleus and plays a crucial role in genetics, medicine, and biotechnology.
Future Directions: Continued research and technological advancements hold promise for new treatments and applications.
Slide 11: Questions and Discussion
Invite Audience: Open the floor for any questions or further discussion on the topic.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...Scintica Instrumentation
Intravital microscopy (IVM) is a powerful tool utilized to study cellular behavior over time and space in vivo. Much of our understanding of cell biology has been accomplished using various in vitro and ex vivo methods; however, these studies do not necessarily reflect the natural dynamics of biological processes. Unlike traditional cell culture or fixed tissue imaging, IVM allows for the ultra-fast high-resolution imaging of cellular processes over time and space and were studied in its natural environment. Real-time visualization of biological processes in the context of an intact organism helps maintain physiological relevance and provide insights into the progression of disease, response to treatments or developmental processes.
In this webinar we give an overview of advanced applications of the IVM system in preclinical research. IVIM technology is a provider of all-in-one intravital microscopy systems and solutions optimized for in vivo imaging of live animal models at sub-micron resolution. The system’s unique features and user-friendly software enables researchers to probe fast dynamic biological processes such as immune cell tracking, cell-cell interaction as well as vascularization and tumor metastasis with exceptional detail. This webinar will also give an overview of IVM being utilized in drug development, offering a view into the intricate interaction between drugs/nanoparticles and tissues in vivo and allows for the evaluation of therapeutic intervention in a variety of tissues and organs. This interdisciplinary collaboration continues to drive the advancements of novel therapeutic strategies.
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
4. SUTURE RELATED PROBLEMS:
Suture
related
problems
features treatment
Exposed
knots
FB Sensation.
Gaint
papillary
conjunctivit.s
Nidus for
infection.
Vascula-
rization.
Rotation
/replace
suture with
knots burried
Broken suture remove
5. Tight suture Persistent
epithelial
defect
Nidus for
infection
remove
Loose suture Exposed
failure to
epithelization
remove
Entanged
suture knots
Can loosen,
Become
exposed
or act as a
nidus
6. Suture
abscess
Poor
prognostic
factor for graft
Can lead to –
• wound
dehiscence
• graft failure
secondary
to infection
• corneal
scarring
•endophtha-
lmitis
Debride
suture roof,
suture & send
for
microbiologic
al
examination
Broad
spectrum
antibiotics
Immune
infiltrate
Immunol-
ogical
reaction to
suture
material/ talc
from surgical
gloves
Topical
steroid and or
ciclosporin
Vascularizati-
on
7. Wound Leaks and Wound
Displacement:
Shallow AC with low IOP on POD 1 –
WOUND LEAK
Shallow/flat AC may occur due to pupillary
block or choroidal detachment.
Siedels test
Prolonged wound leak:
I. persistent fistula
II. Secondry glaucoma
III. peripheral anterior synechia
IV. Significant endothelial loss
V. Epithelial ingrowth
8. CAUSES:
Broken,loose,misplaced suture
Suture track leak - full thickness suture
Suture between thin or necrotic tissue
Excessive gap between suture
Unequal thickness between graft and host
11. EPITHELIAL DEFECTS:
Re- epithelization & maintenance of intact
epithelium is essential for postoperative wound
healing & survival of graft.
Average time for complete epithelization is 4-6 days.
Removal of the histocompatibility antigen on the
donor epithelial cells would decrease the incidence
of allograft rejection. Stulting et al. Showed that
there is no decrease in likelihood of rejection by
doing that.
13. EPITHELIAL DEFECTS-
MANAGEMENT:
Prevent and treat risk factor.
Using nonpreserved artificial tears and limiting medication
toxicity to the epithelium are essential.
Pressure patching -decreasing eyelid motion over the
healing surface.
I f healing not complete in 1 week -BCLCollagen shields.
Autologous serum.
Amniotic membrane transplantation.
I f healing not complete in 2 week-Temporary permanent
tarsorrhaphy.
BotulinumA toxin injected into the levator muscle to
produce a protective ptosis.
Keratoepithelioplasty.
14. POSTOPERATIVE INFLAMMATION:
Topical corticosteroids.
May lead to the formation of intraocular fibrin due to
breakdown of the blood–aqueous barrier.
I. Pupillary block,glaucoma
II. Direct damage to endothelium.
IntraocularTPA (25µg)
15. IRIS INCARCERATION:
Causes:
I. Collapse of AC
II. Inflamed eyesswollen & flaccid iris
III. Poorly placed suture
Closes AC angle at site incarceration
I. Glaucoma
II. Graft failure
Large adhesion at graft host junction localised graft
edema & vascularization.
Manages by-
I. Argon laser iridoplasty
II. viscoelastic substance is injected into the anterior chamber
and the iris is swept out of the wound with an iris or
cyclodialysis spatula introduced through another area of the
wound or through a separate limbal incision.
16. WOUND DEHISCENCE:
Can occur immediately/several years later.
Causes:
I. Trauma
II. Infectious keratitis
III. Suture failure
IV. Spontaneous wound separation
Resuture immediately
18. FILAMENTRY KERATITIS:
Filaments consist of abnormal collections of
mucus and epithelial cells on the corneal
surface.
Usually predominate in the early
postoperative period.
Develop at the graft–host margin.
Foreign body sensation and redness.
Hypotonic artificial tears,topical
acetylcysteine,removed with a forceps,BCL.
19. PRIMARY GRAFT FAILURE:
Gross corneal edema in grafts with large broad
folds immediately after keratoplasty.
Not followed by period of clear cornea.
Factors:
I. Prolonged death-enucleation time
II. Poor donor endothelial count
III. Aphakic and psuedophakic donor
IV. Elderly donor
V. Inadequate preservation
VI. Surgical trauma
VII. HSV infection
20. PRIMARY GRAFT
FAILURE:MANAGEMENT
irreversible edema unresponsive to
hypertonic saline/steroids.
Hyposecretion of aqueous humor, which may
occur after penetrating keratoplasty, may
result in corneal edema due to a decreased
supply of metabolites to the endothelium.
Observe for 3-4 weeks for signs of clearing.
no improvement- repeat PKP.
21. HYPHEMA:
Incidence increase with intaoperative
manipulatons like extensive
synechiolysis,iridoplasty,iridotomy.
Clears spontaneously without treatment.
IOP high- treat aggressively.
Beta-blockers + Brimonidine/acetazolamide
Prolonged persistence-clot irrigation and
aspiration.
22. HIGH IOP & PUPILLARY BLOCK
GLAUCOMA:
Due to:
I. Residual viscoelastics in
AC
II. Uveitis
III. Hyphema
IV. Crowding ofAC angle
V. Pupillary block-it occurs
due to posterior
synechiae.
VI. Forward movement of
lens iris diaphragm.
23. HIGH IOP MANAGEMENT:
Topical glaucoma medicaton-
I. b-adrenergic antagonists
II. Adrenergic agonists
III. Alpha -2 adrenergic agonists
IV. Carbonic anhydrase inhibitor-acetazolamide
V. Hyperosmotic agents
VI. Peripheral iridotomy,surgical iridectomy.
24. LOW IOP:
Causes :
I. Wound leak
II. Iridocyclitis: cilliary shock
III. Cyclodialysis
IV. Choroidal detachment
V. Retinal detachment
25. HSV KERATITIS:
Can incite graft rejection.
Patterns:
I. Dendritic
II. Geographic
Stromal -graft edema,KPs.
Propensity to occur in graft host
junction,absence of khadadaoust line.
Topical acyclovir 5 times a day for 2weeks post-
op.
Oral acyclovir 400mg BD/valacyclovir 500 mg BD
for 1 year.
29. GRAFT REJECTION:
Viable donor cells possessing class 2 and 1 antigen &
major histocompatibility antigen comes in contact
between recepient lymphocytic population,genrates
immune response.
Graft clear for atleast 2 weeks
graft edema + inflammatory signs
30. Graft rejection Clinical features
epithelial Elevated,undualating
line(stains).
Starts near a vessel at GHJ.
Subepithelial infitrates Confined to the graft
02-0.5mm,white
Randomly distributed
Beneath bowmans layer.
stromal Peripheral full thickness
Of corneal haze
endothelial increased corneal thickness
Khodadoust line
(line of pigmented KPs
31. Prednisolone acetate 1percent or dexamethasone
sodium phosphate 0.1 percent eye drops 4 times a
day,with tapering over 1 month.
Dexamethasone eoint at night time.
Endothelial rejection- treated more aggresively.
Sub-tenon injection of methylprednisolone.
Tab. Prednisolone 1mg/kg/day tapered over 1-2
weeks. Or Intravenous methylprednisolone(500mg).
Systemic azathioprine-has potential side effects
Cyclosporine- metabolite of fungus topocladium
inflatum
32. INFECTIOUS CRYSTALLINE
KERATOPATHY:
Chronic, progressive
corneal infection.
Anterior lamella of graft
involved-most
commonly by
streptococcus viridans.
No clinically evident
stromal inflammation.
Crystalline branching
opacities in anterior &
mid stroma
33. URRETS-ZAVALIA SYNDROME:
Permanent fixed dilated pupil after penetrating
keratoplasty/DALK in patients with keratoconus.
Iris atrophy
Secondary glaucoma
Mydriasis unresponsive to miotics.
Unknown etiology (severe iris ischaemia – possible
mechanism).
Management –
I. Reduce IOP
II. Avoid Atropine pre-operatively
III. Peripherally painted Contact Lens for photophobia, glare
34. CORNEAL MEMBRANES:
Epithelial ingrowth (conjunctival/corneal) – through
gap at host-graft junction.
I. cryotherapy with air in the AC to insulate the
intraocular contents.
II. Sugical extiparation.
III. Removal of abnormal tissue with fistula & replaced
with graft.
IV. Prevention of medically uncontrollable glaucoma
& pain using a seton.
Fibrous ingrowth (retrocorneal membrane) –
gray/white fibrous membranes between DM and
endothelium-repeat PKP.
35. HURRICAN (WHORL)/ VORTEX
KERATOPATHY:
due to an antibiotic–
steroid combination
containing neomycin,
polymyxin,
dexamethasone, and
benzalkonium chloride.
whorling spiral
extending from the
peripheral border of
the graft inward.
36. CATARACT:
Incidence varies from 25-80%
Due to –
I. Poor surgical technique
II. Altered lens metabolism
III. Toxic drugs– corticosteroids,
anticholinesterase
37. ASTIGMATISM:
Average – 4-5 D
Higher in eyes with –
I. Scarring due to corneal ulcer
II. Keratoconus
III. Eccentric graft
IV. Mal-aligned graft
V. Faulty suturing techniques
VI. Improper placement of
second suture
VII. Unequal depth
VIII. Non-radial sutures
IX. Tight sutures
X. Unequal distribution of
tension in continuous suture
Surgical precaution to
minimize Astigmatism:
I. Central and sharp trephination
II. Use of a sharp trephine
III. Symmetric suture placement
(especially 2nd suture)
IV. Avoid tight suture placement
V. Suture adjustment (for
continuous suture) or selective
suture removal (for
interrupted sutures)
38. GLAUCOMA:
Most commonly due to PAS and epithelial downgrowth
& then due to steroid induce.
2 unique mechanisms –
I. Collapse of trabecular meshwork
II. Compression of AC angle
Larger Donor Grafts – associated with deeper AC lower
incidence of post-op progressive angle closure and lower
post-op IOPs.
Avoid prostaglandins.
LaserTrabeculoplasty.
Trabeculectomy with MMC Surgery.
39. RECURRENCE OF ORIGINAL
RECIPIENT DISORDER:
Due to migration of recipient keratocytes into graft stroma.
Occurs frequently in –
I. Granular – 100% at 4 years*
II. Macular – 5.2%
III. Lattice – 48%
IV. Reiss Buckler’s dystrophy
V. Central crystalline dystrophy
VI. Posterior Polymorphous dystrophy
Repeat graft
Superficial keratectomy/ Excimer laser Phototherapeutic
keratectomy – for superficial lesions.
40. ENDOPTHALMITIS:
This may occur as a early complication or as late
complication.
Pain ,decreased visual
acuity,hyperemia,chemosis.
Tap from anterior chamber,VitreousTap.
Intensive topical, intravitreal and systemic
antibiotics.
As a late complication it might associated
with suture removal,vitreous incarceration in
keratoplasty wound.
41. VITREORETINAL PROBLEMS:
Retinal Detachment:
Rare
Incidence increases with complicated procedure, especially after
vitreous manipulation.
Macular Edema:
Common cause of non improvement of vision despite clear graft.
Predispositions –
I. Aphakic bullous keratopathy
II. Pseudophakic bullous keratopathy
III. Trauma
IV. Any previous intraocular surgery
Non steroidal antiinfflamory drugs.
42. PHOTOTOXIC MACULAR DAMAGE:
Microscope light induced.
Free radical produced due to interaction of light and
oxygen causes injury to retinal cell mitochondria.
Symptoms- central and paracentral scotoma,decrease
visual activity.
Signs-macular edema followed by gradual pigmentation.