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Devlin Corneal Transplant Flashcards

1
Q

What’s the oldest and first procedure for the human transplant of solid tissues?

A

Penetrating Keratoplasy

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2
Q

How many layers does the PK transplant? What’s the success rate?

A

All of them

90%

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3
Q

How long does a PK transplant last?

A

100 yrs

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4
Q

What’s the main indication for PK?

A

Keratoconus due to Ectasia

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5
Q

What 3 things need to be checked in the pre-eval for PK?

A
  1. Visual potential
  2. Underlying Surface Disease
  3. HSV
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6
Q

What underlying disease is an absolute “no” for PK?

A

Aniridia/Stem Cell dysfunction

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7
Q

What does the normal graft look like 1-day post op for PK?

A

Clear, intact suturing, minimal or no epithelium

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8
Q

What 5 things do you look for after PK transplant?

A
  1. Flat AC
  2. Wound leak
  3. Very low IOP (<5)
  4. Broken/Loose sutures
  5. Infiltrates, infection (endophthalmitis)
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9
Q

What does primary injection from a corneal transplant look like?

A

Edema, clouding, painless

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10
Q

When does re-epithelization found post-op PK?

A

5-7days

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11
Q

When does a 2’ graft rejection occur? What are the sxs?

A

Occurs around 2 wks after transplant

Sudden onset of decreased vision, pain, uveitis

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12
Q

What type of suture?

Continuous suture, easier to perform, tedious to remove

A

Running

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13
Q

What type of suture?

Individual sutures, more difficult to maintain tension symmetry, easier to control astigmatism during removal

A

Interrupted

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14
Q

What layers does a Lamellar keratoplasty transplant?

A

Corneal tissues anterior to descemet’s membrane

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15
Q

What is the only layer of the host cornea saved?

A

Endothelium preserved

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16
Q

What are the 2 indications for LK?

A
  1. Keratoconus

2. Anterior scar secondary to trauma or infection

17
Q

What are the 4 advantages of MDALK over PK?

A
  1. Lower rejection rate
  2. No “open sky” (dc risk of infection)
  3. Easier control of astigmatism/refraction
  4. Decreased healing time/Quicker recovery time
18
Q

What are the 3 disadvantages of PK?

A
  1. Difficult to perform
  2. Potential interface haze/scar
  3. Not proven better visual result vs PK
19
Q

What does DSEK stand for?

A

Descemet’s Stripping Endothelial Keratoplasty

20
Q

What layers are removed in a DSEK?

A

Only remove endothelial cells and Descemet’s membrane

21
Q

What are the indications for a DSEK?

A
  1. Fuch’s Dystrophy
  2. Surgical trauma, bullies keratopathy
  3. Failed PK
22
Q

What is the key step in DSEK?

A

Air bubble is injected into AC to keep pressure on new graft to adhere to host

23
Q

What are the advantages of DSEK over PK?

A
  1. 90%+ of cornea remains intact
  2. Excellent refractive outcome
  3. Recovery time ~ 1 month
24
Q

What are the disadvantages of DSEK?

A
  1. Re-bubble rate is high
  2. Hyperopic shift ~ 2D
  3. AC trauma causes cataract
  4. IOP spike (>50mmHg)
25
T or F: DSEK rejection rate = PK rejection rate
True
26
What procedures is the Fentosecond laser used in?
1. LASIK 2. Cataract sx 3. Softening of nucleus for Phaco 4. MDALK dissection 5. Graft button creation
27
What is the acceptable endothelial count for a donor corneal?
>2700
28
What is the most difficult post-op battle with corneal transplants?
Rejection of donor cornea
29
What is the tx for a primary graft rejection?
Re-graft the cornea
30
When does immune mediated graft rejection occur?
4-6 wks and beyond | - can occur anytime for the life of the transplant
31
Epithelial graft rejections make up what % of graft rejections? What's the tx for this?
10% of rejections Replace donor epithelium by hosts epithelium
32
Though uncommon, when would a stromal rejection occur post-op? What reduces the chances of rejection?
~ 2 months Host stromal cells replace donor's over life of transplant
33
What % of graft rejections are endothelial? What ant. seg finding can be noted during SLE?
90% of true graft rejections | Khadadoust line
34
What is a khadadoust line a collection of?
Collection of WBCs forming a thing line across endothelium
35
How do you tx a severe of chronic rejection of a graft?
1. q1h topical corticosteroid 2. Oral prednisone 3. Start with Medrol Dose Pak
36
How do you tx any pt after corneal transplant sx?
1. Prednisolone Acetate 1% q2h | 2. 4th Gen. FQ QID (Zymaxid, Moxeza, Besivance)
37
What are some clinical triggers of corneal transplants?
1. Vascularization - large grafts close to Lim also region | 2. Loose or broken sutures - remove immediately
38
What's the most common cause of poor vision in a clear, compact graft?
Refractive management

Anterior Segment 2 (14 decks)

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