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Partnerships for Success: Corneal Transplant in the 21st Century Breakout Session A Presenters: Christopher Blanton, MD Medical Director, Ocular Services, OneLegacy Jessica Horton Respiratory Therapist & Cornea Recipient, Antelope Valley Hospital Moderator: Sherri Lamon, RN, PIH Health Objectives • Understand the importance of good eye care • Recognize the benefits of timely referrals • Be aware of indications for corneal transplant and innovative remedies. Question to Run on • How do your actions in the hospital affect the gift of sight? The Basics The goal of the cornea is to focus light to a point on the retina. What two requirements are necessary for the cornea to perform this function? Transparency and correct shape Corneal Anatomy • Epithelium- 50 microns • Bowman’s Layer- 12 microns • Stroma- 450-900 microns • Descemet’s membrane- 3-12 microns • Endothelium- 4-6 microns Corneal Anatomy Corneal Transplant Surgery Trephine of Donor Tissue Trephine of Donor Tissue Trephine of Donor Tissue Trephine of Donor Tissue Initial Incision into Eye Removal of Diseased Corneal Tissue "Open Sky" Portion of Surgery Sewing donor tissue into place Suturing Healthy Donor Tissue into Place Pseudophakic Bullous Keratopathy Bullous Keratopathy-Fuchs' Dystrophy Endothelial Disease Failed Corneal Transplant Keratoconus Keratoconus – Advanced Corneal Scar Corneal Scar – High Mag Corneal Scar Infectious Viral Corneal Scar – Infectious Bacterial Corneal Perforation Corneal Dystrophies Corneal Dystrophy Treated with Excimer Laser Chemical Burn Partial Thickness •DLEK •DSEK •DSAEK Deep Lamellar • Replacing Descemet’s and Endothelial layer • Difficult dissection technique for both donor and host cornea Descemet’s Stripping • Manual Dissection-host and donor • Automated -donor DSAEK Graft IntraLase Enabled Keratoplasty The IntraLase Enabled Keratoplasty software can be programmed to produce different configurations with computer precision. Historical use of trephination utilizing different shapes has taught us that different configurations have unique features that can be used for specific indications. IntraLase Enabled Keratoplasty The IntraLase® FS ophthalmic surgical laser is cleared for the creation of a lamellar cut/resection of the cornea for lamellar keratoplasty and for the creation of a PENETRATING CUT/INCISION for penetrating keratoplasty The IntraLase FS surgical laser can perform the following cuts that when combined at different angles can create various geometrically shaped corneal resections at the surgeon’s desired depth. IntraLase Enabled Keratoplasty The IntraLase Enabled Keratoplasty application allows the user to perform three cut segments: a posterior side cut, lamellar cut, and anterior side cut. The IntraLase Enabled Keratoplasty application allows the user to perform three cut segments: a posterior side cut, lamellar cut, and anterior side cut. Cut Angles Red Blue Yellow Dotted line 90 degrees 30 degrees 150 degrees angle measurement Example Pattern Combinations Actual Surgery OCT of Standard PK OCT of Zig-Zag IEK Key Elements in Caring for Potential Donors • Making the Referral • Approach for Donation • Maintain the Opportunity • Ventilated or Comatose Patients Making the Referral • Report all imminent/cardiac deaths within ONE HOUR • Regardless of medical condition, age, advanced directive • HIPAA compliant Why? • Allows time to serve the family • Preserves organ and tissue viability • Ensures compliance with federal and state laws Approaching for Donation • Most deaths will not be eligible for donation • Do not approach independently of OneLegacy. • Have medical chart available for OneLegacy to determine suitability. • LNOK contact information Maintain Opportunity for Corneal Donation • Ventilated or comatose patients- lubricate eyes frequently : every 4-6 hours gel is better than tears • Deceased patients- wait for go ahead from One Legacy: eye care may interfere with M.E./coroner's investigation. Poor Eye Care Can Damage the Cornea Healthy Donor Tissue Cures Blindness Partnerships for Success: Corneal Transplant in the 21st Century Jessica Horton Respiratory Therapist & Cornea Recipient Antelope Valley Hospital Question to Run on • How do your actions in the hospital affect the gift of sight? For more information… (213) 207-4200
