Keratoplasty

KERATOPLASTY


KERATOPLASTY

  • Keratoplasty (Corneal grafting or Corneal transplantation) is an operation in which the patient’s diseased cornea is replaced by the donor’s healthy clear cornea, obtained by cadavers.
  • Donor cornea taken from the cadaver within 6 hrs after death (Golden period)
  1. Short term storage (upto 48 hours) – whole globe is stored at 4°C in a moist chamber
  2. Intermediate storage (upto 2 weeks) – in Mc Carey Kaufmann medium
  3. Long term storage (upto 35 days) – organ culture method or cryopreservation at minus 70°C
  4. Early complications – flat AC, iris prolapse, infection, secondary glaucoma, epithelial defects, primary graft failure
  5. Late complication – graft rejection, recurrence of disease, astigmatism
  6. Contraindications – Cruetzfeldt-Jacob disease, SSPE, rubella, rabies, IM, HIV, Hepatitis, syphilis, retinoblastoma, active inflammation.

Corneal grafts

  • Corneal grafts can be of following types:
  1. Full thickness or penetrating keratoplasty
  2. Partial thickness or lamellar keratoplasty
  • The cornea graft with graft diameter b/w 7 & 8.5 mm has more chances of survival.

In keratoplasty the diseased corneal disc is replaced by a corresponding sized graft from a human cadaver eye.

Penetrating (full thickness) keratoplasty

Lamellar (partial thickness) keratoplasty

Keratoconus               

  • Interstitial keratins
  • Salzmann’s nodular dystrophy
  • Mycotic corneal ulcer
  • Corneal abscess
  • Corneal dystrophy
  • Disciform keratitis
  • Recurrent pterygia

Complications of keratoplasty

  • Anterior synechia
  • Vascularization
  •  Secondary glaucoma
  • Rejection of graft
  • A corneal graft which be obtained within 4 hours of death carries good prognosis.
Exam Question
 
  • Cornea should be removed from cadaveric donors within 6 hrs after death (Golden Period).
  • Short term storage (upto 48 hours) – whole globe is stored at 4°C in a moist chamber.
  • Intermediate storage (upto 2 weeks) – in Mc Carey Kaufmann medium.
  • Long term storage (upto 35 days) – organ culture method or cryopreservation at minus 70°C.
  • The cornea graft with graft diameter b/w 7 & 8.5 mm has more chances of survival.
  • Deep anterior lamellar keratoplasty is indicated in Superficial corneal opacities.
  • Endothelial cell loss in donor tissue of Descemet stripping endothelial keratolplasty is nearly 36%.
Don’t Forget to Solve all the previous Year Question asked on KERATOPLASTY

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