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28/04/2010
1
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