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Anterior Segment 2 > Devlin Corneal Transplant > Flashcards

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
Q

T or F: DSEK rejection rate = PK rejection rate

A

True

26
Q

What procedures is the Fentosecond laser used in?

A
  1. LASIK
  2. Cataract sx
  3. Softening of nucleus for Phaco
  4. MDALK dissection
  5. Graft button creation
27
Q

What is the acceptable endothelial count for a donor corneal?

A

> 2700

28
Q

What is the most difficult post-op battle with corneal transplants?

A

Rejection of donor cornea

29
Q

What is the tx for a primary graft rejection?

A

Re-graft the cornea

30
Q

When does immune mediated graft rejection occur?

A

4-6 wks and beyond

- can occur anytime for the life of the transplant

31
Q

Epithelial graft rejections make up what % of graft rejections? What’s the tx for this?

A

10% of rejections

Replace donor epithelium by hosts epithelium

32
Q

Though uncommon, when would a stromal rejection occur post-op? What reduces the chances of rejection?

A

~ 2 months

Host stromal cells replace donor’s over life of transplant

33
Q

What % of graft rejections are endothelial? What ant. seg finding can be noted during SLE?

A

90% of true graft rejections

Khadadoust line

34
Q

What is a khadadoust line a collection of?

A

Collection of WBCs forming a thing line across endothelium

35
Q

How do you tx a severe of chronic rejection of a graft?

A
  1. q1h topical corticosteroid
  2. Oral prednisone
  3. Start with Medrol Dose Pak
36
Q

How do you tx any pt after corneal transplant sx?

A
  1. Prednisolone Acetate 1% q2h

2. 4th Gen. FQ QID (Zymaxid, Moxeza, Besivance)

37
Q

What are some clinical triggers of corneal transplants?

A
  1. Vascularization - large grafts close to Lim also region

2. Loose or broken sutures - remove immediately

38
Q

What’s the most common cause of poor vision in a clear, compact graft?

A

Refractive management

Anterior Segment 2 (14 decks)

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