Post-PKP

Question 1

Thermokeratoplasty

Answer 1

Heat shrinking stromal collagen

Question 2

Lamellar keratoplasty

Answer 2

3/4 incision w/ endothelium attached

Question 3

Epikeratophakia

Answer 3

Debridemnt epithelium and suture graft w/ nylon sutures. Tighten until flattened required amount.

Question 4

When would you do a Mushroom PKP?

Answer 4

More epithelial cells in graft. If host cornea has more defects and needs more epithelium.

Question 5

When would you do a Top Hat PKP?

Answer 5

Posterior pathology; host cornea needs more endothelium. More cells in graft.

Question 6

What makes patients more prone to graft failure?

Answer 6

Neovasc

Question 7

When does early graft failure occur?

Answer 7

Within 6 mos

Question 8

What are the signs of early graft failure?

Answer 8

Cloudy due to endothelial dysfunction; defective donor or surgical trauma

Question 9

When does late graft failure occur?

Answer 9

1 year or later

Question 10

What are the signs of epithelial rejection?

Answer 10

Linear opacities, SEI, iritis

Question 11

What are the signs of endothelial rejection?

Answer 11

iritis, inflammation at junction, linear precipitates, corneal edema, periorbital injection

Question 12

Usually no Sx with graft rejection, but some are:

Answer 12

Decrease in VA, redness, pain, irritation, photophobia

Question 13

When can lenses be fit?

Answer 13

• After stitches are removed
• Ks are stable
• Refraction is stable
• No signs of rejection
• No more steroids.
• Usually 6-18 months post-surgery