A safer alternative approach to penetrating keratoplasty in opaque corneas

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dc.contributor.authorVenugopal, Anithaen_US
dc.contributor.authorChandratreya, Madhura Pen_US
dc.contributor.authorGhorpade, Aditya Sen_US
dc.date.accessioned2023-08-25T06:33:43Z
dc.date.available2023-08-25T06:33:43Z
dc.date.issued2022-07
dc.description.abstractBackground: This video demonstrates a useful technique of keratoplasty which can be routinely undertaken by all surgeons when imaging modalities such as anterior segment optical coherence tomography are not available and prior patient history is not forthcoming. Purpose: To demonstrate a technique of lamellar separation and layer by layer removal of host cornea when dealing with keratoplasty in perforated corneal ulcers, adherent leucomas, dense corneal opacities, which obscure visualization of the iris and anterior chamber details. Synopsis: In this video, we demonstrate penetrating keratoplasty in a failed opacified graft with iridocorneal adhesions, with no visualization of anterior chamber details. Lamellar dissection of the host cornea is done starting at its periphery and moving centrally, with gentle peeling of the superficial layers, the epithelium and bulk of stroma, following which, the deeper portion of the cornea is dissected and separated from underlying adherent iris tissue. Layer by layer separation allows better visualization through the remaining thin layers of the cornea. This permits fine dissection and layered removal of the cornea, thereby avoiding injury to iris and lens. Debulking of the host cornea decreases the force that is needed to be applied to separate adherent iris tissue from the host cornea, and reduces the chances of sudden entry into the anterior chamber and subsequent damage to the iris or lens. This also reduces the chance of iris tears, iridodialysis and bleeding from the iris and helps maintain iris integrity, which is essential intraoperatively for protection of lens and anterior chamber formation, and to avoid glare and photophobia postoperatively. Preventing iris damage also reduces the chances of formation of peripheral anterior synechiae (PAS), which can predispose to graft rejection, graft failure and secondary glaucoma. Highlights: Layer by layer corneal separation beginning inside the graft host junction, careful separation of iridocorneal adhesions and PAS is a helpful technique to optimally preserve the anterior segment anatomy during difficult cases of penetrating keratoplasty.en_US
dc.identifier.affiliationsCornea and Refractive Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, Indiaen_US
dc.identifier.citationVenugopal Anitha, Chandratreya Madhura P, Ghorpade Aditya S. A safer alternative approach to penetrating keratoplasty in opaque corneas. Indian Journal of Ophthalmology. 2022 Jul; 70(7): 2777en_US
dc.identifier.issn1998-3689
dc.identifier.issn0301-4738
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/224410
dc.languageenen_US
dc.publisherAll India Ophthalmological Societyen_US
dc.relation.issuenumber7en_US
dc.relation.volume70en_US
dc.source.urihttps://doi.org/10.4103/ijo.IJO_1428_22en_US
dc.subjectPenetrating keratoplasty, Lamellar technique, Adherent leucomas, Perforated corneal ulcers, Opaque corneasen_US
dc.titleA safer alternative approach to penetrating keratoplasty in opaque corneasen_US
dc.typeJournal Articleen_US
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