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CORNEAL SURGERY

Dr Frank FAMOSE

DVM, CES Ophtalmologie

Ekaterinburg May 2010

Surgical anatomy of cornea

►Precorneal tear film

►Epithelium

►Stroma

►Descemet’s membrane

►Endothelium

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Corneal healing

►Edema

►Vascularisation

►Scar formation

►Pigmentation

►Degeneration

►Avascular healing

►Vascular healing

Corneal preparation

► Hair clipping

►Desinfection

►Draping

►Ocular fixation

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Corneal surgery : microscope

Corneal surgery : material

►Cutting knives►Disposable►Blade-holders

►Dissection knives

►Trephines

►Scissors

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Corneal surgery : material

►Grasps & forceps

►Needle-holder

►Suture material

KERATECTOMIES

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Indications : superficial corneal diseases►Corneal dermoïds

►Corneal lipidosis

►Recurrent corneal erosions

►Feline corneal sequestra

Corneal surgery : keratectomies

►Indications

►Practical realisation

►Results

►Follow-up

►Complications

►Technical aspects Superficial

keratectomy

Superficialkeratotomy

Corneal biopsy

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Superficial keratectomy : indications►Corneal dermoïds

►Corneal lipidosis

►Feline corneal sequestra

►Inflammatory keratopathies

Superficial keratectomy : practical realisation►Corneal incision

►Stroma dissection & separation

►Removal of corneal parts

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Superficial keratectomy : results

►Transparency

►Vascular invasion

►Pain

►Pigmentation

Superficial keratectomy : Follow-up►Post-operative

treatment Local antibiotics Local corticosteroïds ?

►Follow-up

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Superficial keratectomy : complications

►Infection

►Fibrosis

►Delayed healing

►Pigmentation

Punctuate and grid keratotomy : indications►Non healing

superfical corneal ulcers in dogs

►R/O other causes

►Not in cats

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Punctuate and grid keratotomy : practical realisation►Epithelial

debridement

►Anterior stromal keratotomy

►Corneal protection

Punctuate and grid keratotomy : results►Epithelial healing

►Vascular invasion

►Pain

►Pigmentation

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Punctuate and grid keratotomy : Follow-up

►Ulcer healing

►Medical treatment

Punctuate and grid keratotomy : complications►Non-healing ulcers

►Corneal granuloma

►Deep stromal inflammation

►Corneal scars

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CONJUNCTIVALGRAFTS

Indications

►Deep corneal defects

►Ocular perforation

►Keratomalacia

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Types of conjunctival grafts

►Pedicule

►Island graft

►Bridge

►Complete

Practical realization

►Corneal preparation

►Graft preparation

►Suture

►Debridement►Sepsis treatment

►Subconj. injection

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Practical realization : pedicle

►Indications Central Paracentral

►Difficulties►Graft’s dimensions►Tension

Practical realization : island

►Indications►Central►Paracentral

►Difficulties►Manipulation of graft

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Practical realization : complete

►Indication Large central Multiple lesions keratomalacia

►Difficulties No corneal

visualisation

Follow-up

►Sutures

►Tissue Retraction

►Leakage (if perforated)

►Removal of pedicle

►D2 to D10

►D7

►D2xxxxxxxxxxxxxxxxx

►D21

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Complications : causes

►Sutures or knots failure

►Incomplete covering

►Leakage

►Oblic graft direction

►Excessive tension or stretching

►Wound infection

►Incompletepreparation of cornea

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Conclusion

►Surgical rules and material

►Simple techniques for keratectomy

►Many technical possibilities with conjunctival grafts