Corneal grafts Flashcards
(22 cards)
What are the risks of a corneal graft?
Anterior uveitis
Infection
Rejection
Failure
Secondary cataract
Secondary glaucoma
How long does it take for vision to recover after a corneal graft?
Up to 18 months
What are the types of corneal graft?
Penetrating keratoplasty (PK)
Deep lamellar keratoplasty (DALK)
Descemet’s stripping endothelial keratoplasty (DSEK)
How is PK performed?
~8mm button of cornea is replaced
Sutured with a continuous suture or 16 separate sutures
How is DALK performed?
Posterior stroma left behind
Descemet’s membrane sometimes removed
How is DSEK performed?
Posterior cornea is transplanted via small incision
Less sutures used than PK
What is the post op care for PK?
Antibiotics 1 month
Topical steroids up to 5 years
Weekly review, then monthly
Sutures removed at 9 months
Refraction at 9 months
What is the post op care for DALK?
Shorter meds than PK
Refraction at 6 months
What is the post op care for DSEK?
Antibiotic 1 month
Cyclo 1 week
Anti-inflam up to 2 years
Refraction @ 6 months
What are the post op complications for PK?
Rejection
Failure
What are the post op complications for DALK?
Rejection (less likely than PK)
Failure (endothelial failure unlikely)
Graft dehiscence (tissue separates between donor and host)
What are the post op complications for DSEK?
Epithelial ingrowth
Rejection
Secondary glaucoma
CMO
What is graft rejection and how quickly does it usually occur?
An immune response to donor tissue
Within 18 months
What is graft failure?
Decompensation of endothelium
Failure to heal
No inflammation or infection
What are the signs of graft rejection?
Linear infiltrates (epithelial, subepithelial, stromal)
AC activity
Haze
Redness (limbal)
Keratic precipitates
Khodadoust line on endothelium with oedema and limbal injection (endothelial rejection)
What are the signs of graft failure?
Oedema
Haze
Bullae
No AC activity
Minimal/no limbal injection
What are the sxs of graft rejection?
Blurred vision
Redness
Pain
Photophobia
Epiphora
What is the management for graft rejection?
Same day referral to HES
What is the management for an IOP spike in corneal graft pxs?
Treat with caution
Refer if over 22mHg
What is the treatment for graft rejection?
24 hour topical steroids
Cycloplegia
Maybe topical cyclosporine
Systemic steroids
Systemic immunosuppressants
Maybe subconjunctival steroid injection
What are the risks for graft rejection?
Large graft (>8-9.5mm)
Previous rejection
Younger age
Exposed sutures
Trauma
Males
Donor tissue antigen sensitivity
Infection or inflammation
Glaucoma
Decrease in steroids
Tear deficiency
Iris adhesion
Further intraocular surgery
What are the post-op complications of laser refractive surgeries?
Tear instability
Wrinkling/distortion/dislocation of the flap
Subepithelial haze
Persistent epithelial defects
Epithelial ingrowth under flap
Diffuse lamellar keratitis (sands of the sahara)
Bacterial keratitis
Corneal ectasia
