Corneal Transplantation Rasik B Vajpayee, Namrata Sharma, Ritu Nagpal
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table
A
Ab externo approach 318
Ab interno approach 318
Aberrant lashes 103
Abscess, corneal 496f
Acanthamoeba
corneal ulcers 339, 340
infection 58, 339
keratitis 7, 105, 215f, 331, 335, 337, 338
Acetazolamide 142
Acid 7
burns 408
Adenovirus 7
Ahmed glaucoma valve 143
Air
bubbles, central migration of 200f
dissection 262
reinjection 274
Akinesia 184
Alkali burns 489
Alkaline 7
Allogeneic graft rejection 149
Alopecia 105
Alpha-1 antitrypsin 489
Alpha-1 proteinase inhibitor 474
Alpha-2 adrenergic agonist 142
Amadeus II artificial anterior chambers system 364, 364f
Amblyopia therapy 329
Amebicidal drugs, topical 105
American Society of Cataract and Refractive Surgery 247
Ametropia 153
Amniotic membrane 436, 436f, 441, 491
graft 491, 492
preparation of 442
transplantation 127, 435, 437f, 438f, 440f, 441f, 442, 442f, 493, 522, 527
Amyloidosis, primary 520
Anemia 105
Anesthesia 81, 184, 209, 251, 257, 282, 321, 487, 520
complete corneal 489
general 363
Anesthetic abuse, topical 489
Aniridia 7, 243, 506
congenital 409
Anis corneal marker 68f
Anterior chamber 100, 263, 315
abnormalities 287
angle, crowding of 129
cleavage syndrome 10
intraocular lens 10, 243, 250, 272f, 316, 382
implant 312f
maintainer 231, 232f, 263, 266f
optical coherence tomography 32
Anterior corneal dystrophies 520, 523
Anterior iris synechia 499f
Anterior lamellar
keratectomy 195, 209
keratoplasty 4, 186, 194, 203, 309, 322, 360, 374, 403
Anterior segment 16
evaluation 497
examination of 313
optical coherence tomography 21, 22f, 32, 175f, 195, 204, 205f, 209, 251, 280, 358f, 359f, 360, 375, 382, 383f, 384f, 425f, 457f, 463f, 468, 490f, 520
surgery 27
Anterior staphyloma
acquired 485, 485f
congenital 484, 485
large 497f
Antibiotics 91
Antiglaucoma medications 91
Antimicrobial therapy 337
Antineutrophilic cytoplasmic antibodies 490
Antiviral prophylaxis 147
Anvil-profiled grafts 345
Anwar corneal scissors 364f
Aphakia 243, 315
Aphakic bullous keratopathy 10, 250, 274f, 312, 312f
Aphakic corneal edema 7
Aphakic eyes 135, 314
Arcuate keratotomy 153, 154f
Artificial anterior chamber 178f, 220f, 228, 228f, 229f, 235, 236f, 251, 257, 258f, 360, 364, 364f
Artificial chamber cover 228
Artificial cornea, development of 547
Aspergillus flavus 334
Aspiration cannulas 75
Astigmatism 133, 155f, 242, 368, 398, 403
corneal 90f, 174f
intraoperative adjustment for 90
irregular 7
postoperative 367
regular 152
Australian Corneal Graft Registry 28
Authority for Removal of Human Organs 44
Autokeratoplasty 395, 398f, 400
bilateral 400
contralateral 395, 400
rotational 395, 396
types of 395, 400
Autologous serum 127, 414, 522
Automated descemet stripping endothelial keratoplasty 261
Automated lamellar
dissection 236f
keratoplasty, microkeratome-assisted 180f
therapeutic keratoplasty 4, 47, 49, 177, 181, 181f, 182, 182f, 228f, 229f, 360
contraindications of 177
indications of 177
machine 166, 168f, 169f, 178f
outcomes of 181
surgical trolley 178f
system 419
transplantation procedures 50t
Azathioprine 105, 106
B
Balanced salt solution 204, 308, 532
plus 96
Band keratopathy 7, 435, 439, 445, 520, 526
post-debridement 436
Bandage contact lens 127, 391, 410
placement of 521
Barraquer eye speculum 67
Barraquer tonometer 179
Barron's artificial anterior chamber 257, 257f, 258f
Barron's punch 70f
Barron's radial vacuum trephine 86
Barron's vacuum punch 70
Basement membrane, disruption of 454f
Beer belly appearance 9f
Belin ambrosio enhanced ectasia display 454
Best-spectacle-corrected visual acuity 15, 48, 142, 175, 215f, 227, 251, 362, 420, 421, 520, 541
Beta-adrenergic blocking agents 142
Bi-curve needles 78
Big bubble formation
confirmation of 199
failure of 201
Big bubble technique 172, 194, 198, 217
Bimatoprost 142
Bioactive sutures 79
Biohazardous waste disposal 51
Birth trauma 323
Blade breaker 73, 166, 167f
Bleeding
excessive 120
intraoperative 295
Blindness
corneal 53
major causes of 53
Blood sugar levels 490
Blue sclera 474
syndromes 474
Bone marrow suppression 105
Boston keratoprosthesis 513, 517f
assembly of 514
postoperative appearance of 513f, 517f
surgery 513
Bowman's layer 191
dystrophies 520
lenticule, preparation of 387, 387fc
transplantation 191, 191f, 386388, 388fc
indications of 386, 386fc
Bowman's membrane 387, 474
Brightbill polytef cutting block 72
Brimonidine 142
Brinzolamide 142
Brittle cornea syndrome 474
Bubble
creation 263
types of 262
Bullous keratopathy 271f, 312, 440f, 521f, 524
Buphthalmos 7
Busin glide 168, 170f, 229
C
Candida albicans 241
recurrence of 334f
Cannula assisted big bubble deep anterior lamellar keratoplasty 209
Capsulotomy 306
Carbonic anhydrase inhibitors 142
Carpoligna pleurothecii 489
Castroviejo
calipers 68, 68f
eye speculum 67
trephine 69, 164
Cataract 105, 133, 478
concomitant 283f
extraction 303, 306
removal 489
surgery 91, 157, 461
dilate pupil for 257
Cataractous lens 304f
Cell expansion 410
Central corneal opacity 532f
congenital 323f
Central corneal scarring, congenital 322f
Central corneal thickness 142, 304, 363, 368
Centrifugal lamellar dissection 224f
Chandler's syndrome 7
Chemical burns 172, 304, 408, 414, 436, 441f, 497f
Chemical injury 7, 10, 506, 510f
severe 506
Chemical reduction methods 534
Chlamydial keratitis 7
Chlorhexidine 105
Choroidal detachment 124
Christmas tree
configurations 374
keratoplasty 344, 344f
Churg-Strauss syndrome 349
Cicatrizing dry eye 489
Clear graft after suture removal 109f
Clear lamellar corneal transplant 190f
Clear lens extraction 157
Colibri forceps 74, 74f, 167f, 232, 232f
Collaborative corneal transplantation studies 147
Collagen cross-linking 459, 489
Colletotrichum corda 489
Compound curve needles 78, 79
Compression sutures 154
Computer simulation 397
Cone decompressing incisions 219
Confocal microscopy 18, 19f
Conjunctiva 16
Conjunctival autograft 526
Conjunctival buttonholes 546
Conjunctival flaps 491, 493
complications of 546
Conjunctival injection 105
Conjunctival limbal autograft 408, 409, 413t
Conjunctival peritomy 498f
Conjunctival scarring 11f
Conjunctival scissors 73
Conjunctivitis, allergic 409f
Contact lens 108, 109, 111f, 412, 459
fitting method 109
options 110
types of 109
wear 409
Continuous curvilinear capsulorrhexis 306
Continuous sutures 90
Conventional circular trephines 69
Conventional penetrating keratoplasty 355
Copy and fix technique 346, 351
Cornea 11, 16, 42
central 173f
component surgery of 547
distribution of 45
herpes simplex viral disease of 336
inflammatory diseases of 389
recovery of 45
Corneal cross-linking 527
Corneal curvature 540
Corneal decompensation 270f
Corneal degenerations 7, 362
recurrence of 367
Corneal Dellen 489
Corneal dermoids 323
Corneal diameter 173f
Corneal disease 50
burden of 480
elimination of 7
Corneal dystrophy 50, 361, 436
Corneal ectasia 50, 391, 475t
Corneal edema 128f, 323, 528
Corneal endothelial punch systems 72, 84
Corneal endothelium 425f
Corneal epithelial defect 435, 442f
Corneal epithelialization, failure of 411
Corneal epithelium, removal of 520
Corneal evaluation 31, 33
Corneal fistulas 391
Corneal graft 104, 105, 334f
postoperative care of 99
rejection 146
surgery, evaluation of 3
Corneal haze 526
Corneal hysteresis 455
Corneal laceration 323
Corneal lesions, excision of 436
Corneal marker 169, 170f, 231, 231
Corneal marking instrument 68, 171
Corneal melt 50
Corneal membranes 132
Corneal needle tattooing 535
Corneal neovascularization 80
Corneal opacities 10, 304, 531, 542f
congenital 480
unilateral 542f
Corneal patch graft 391
Corneal pathologies 496
Corneal perforation 10, 50, 277, 391, 480, 480f, 546
Corneal punch 170f
Corneal resistance factor 455
Corneal scars 204, 362, 480
postinfectious 17f
Corneal scissors 73, 87, 87f, 166
Corneal sequelae 436
Corneal storage 34
Corneal stroma 199, 201f, 547
ablation of 520
anterior two-thirds of 199f
posterior 199f
Corneal stromal
dystrophies 198
edema 8f
graft rejection 201
neovascularization 437f
pathologies 527t
Corneal surgery 49, 547
Corneal sutures, completion of 89
Corneal tattooing 172, 482, 534, 534f, 535, 536
Corneal thickness 218f, 395
Corneal tissue 43, 58, 230f, 462f
Corneal topography 280, 454, 520
Corneal transplantation 3, 5t, 47, 50, 152, 152t, 301, 306, 309, 360, 415, 451, 503
center 47, 47f
eye banking for 24
process of 24
secondary microbial 325
surgery 7, 67
Corneal trephine 69, 71, 163, 164
Corneal triple procedures 309
Corneal ulcer 436, 445, 485f
chronic nonhealing 391
perforated 480, 480f
Corneoiridic scars
severe 480
ultrasound biomicroscopy of 21f
Corneolenticular injury 305f
Corneoscleral button 84
Corneoscleral disk 35t
Corneoscleral infection 497f
Corneoscleral laceration 323
Corneoscleral rim sectioning 30
Coronavirus disease 2019 (COVID-19) 26
Coroner's consent 42
Corrected distance visual acuity 152, 309, 463, 527
Cortical matter
aspiration of 307
irrigation of 307
Corticosteroids 91, 105, 339
topical 147
Cosmetic keratoplasty 9
Cottingham corneal punch 72
Crab-claw pattern 454
C-reactive protein 490
Crescent knife 166
Crescentic lamellar
keratoplasty 350, 462f
resection 355
Creutzfeldt-Jakob disease 25
Crystalline lens status 287
Cultured corneal endothelial cells 547, 549
Curvature 78
Curved Vannas scissors 73, 74, 218, 219f
Cyanoacrylate glue 492
Cyclodestructive procedures 143
Cyclodialysis 124
Cycloplegics 91
Cyclosporine 105, 106, 149
Cystoid macular edema 310, 314
D
Damaged donor button 120
De Wecker's iris scissors 74
Death, certification of 42
Deep anterior lamellar keratoplasty 4, 8, 49, 50, 152, 172, 185, 186, 190f, 194, 198, 203, 204, 204f, 209, 213, 215f, 216f, 217, 251, 278, 303, 325, 344, 374, 386, 419, 427, 478f, 491, 492, 493, 493f, 547
conventional techniques of 213
modified 420f
technique 189f, 217, 227f
Deep lamellar endothelial keratoplasty 4, 234, 235f, 242, 264, 286, 318, 382, 385
Deep lamellar keratoplasty 50, 188f, 213, 214f, 356f
Deep stromal femtosecond incisions 377
Deep stromal opacity after deep anterior lamellar keratoplasty 383
Dendritic cells 467
Dense fibrinous membranes, removal of 499
Dense iridocorneal adhesions 498f
Descemet flap 378
Descemet membrane 7, 8, 18, 89, 121, 172, 186, 194, 194f, 196, 196f, 198, 199f, 200f, 201f, 205, 209, 213, 214, 217, 219, 230, 231, 232f, 234, 235f, 238, 241, 247, 256, 262, 264f, 265f, 272, 282, 286, 352, 353f, 362, 377, 382, 387, 419, 428, 429f, 431f, 454, 474, 485, 488, 489, 549
automated endothelial keratoplasty 262
detachment 126, 428
endothelial cell complex 247
endothelial keratoplasty 8, 17, 27, 35, 36, 152, 168, 230f, 243, 247, 250, 253f, 262, 286, 287f, 292f, 293f, 297, 303, 374, 382, 430, 431f, 547
graft detachment 295f
graft injector 231, 231f
surgery 229
endothelium complex 230
folds 8f
perforation 214, 217
selective replacement of 228
wrinkles 366
Descemet rupture 213
Descemet spatula 232, 232f
Descemet stripping
anterior lamellar keratoplasty 429
automated endothelial keratoplasty 5, 19, 27, 35, 47, 48f, 50, 141, 152, 166, 171, 228, 230f, 234, 235f, 242, 243, 247, 250, 256, 262, 272, 277, 278, 280, 286, 303, 374, 382, 478, 547
busin forceps 168, 170f
forceps 230, 230f
spatula 168, 170f, 231
surgery 204
triple procedure 283f, 284f
endothelial keratoplasty 5, 8, 17, 235f, 242, 256, 260, 262, 286, 318
manual dissection technique of 256
Descemetocele 435, 437, 488, 489t, 490f, 493fc
etiology of 489b
investigations for 490b
Descemetorhexis 5, 243, 252, 318
Desmarre's lamellar dissector 165, 165f
Diabetes mellitus 490
Diamond crescent blade 238
Diamond knife 73, 166, 218
assisted deep anterior lamellar keratoplasty 217
micrometer 218f
Diffuse lamellar keratitis 519, 520
Diffuse leucomatous corneal scarring 8f
Digital image manipulation 402
Diode laser cyclophotocoagulation 481, 485
Direct inoculation methods 535
Disk knife 174f
Disposable handheld trephine 164f
Disposable trephine 69, 229, 230f
Distance visual acuity 16
Donor
and host corneal tissue, nonmechanical laser trephination of 86
cap, preparation of 363
cornea 424f
button, manual preparation of 499f
disease transmission from 25, 136
dissection, instruments for 164
endothelium 357
placement of 88
preparation 424
superficial punctate keratopathy of 95f
suturing of 88
tissue management 81
trephination of 83, 306
endothelial cell count 256
eye 395, 396, 410, 412
graft
insertion 264, 267f
preparation 263, 266f, 288f
lamellar tissue preparation 258
lenticule
preparation of 178, 200, 281
transplantation of 259, 283
placement over anterior chamber 179
preparation 30, 219, 287, 343, 344, 371, 419
complications of 261t
technique 289f, 290f
recipient apposition 179, 424
risk assessment interview 29
selection 24, 28
tissue 210, 287
lamellar dissection of 256
preparation of 187
prerequisites 256
transplantation of 293
use of 25
trephines 83
Dorzolamide 142
Double anterior chamber, formation of 201
Double bubble technique 198, 199
Double continuous suture technique 94, 96, 96f, 98
Double corneal forceps 74
Double pass technique 237
Dovetail keratoplasty 345, 345f
Dry eye 10, 103
disease 436
Dry manual deep anterior lamellar keratoplasty 172, 175f
Dystrophy 367
recurrence of 525f
E
Eccentric graft 120f
Eccentric penetrating keratoplasty 477
Ectasia 7, 455
advanced 172
Ectodermal dysplasia 409
Ehlers-Danlos syndrome 474
Electron microscopic 467
Electrophysiological tests 22
Electroretinogram 22, 305
Electroretinography 321
Elevated corneal lesions 520, 523
Endophthalmitis 131, 510
Endothelial cell 55f
count 401
density 28, 253, 267, 297, 303
loss 241, 368, 398, 405, 421
sheet 549f
Endothelial decompensation 250, 278f
Endothelial disorders 234
Endothelial dysfunction 256
Endothelial dystrophy 7
congenital hereditary 7, 10, 322, 323, 430f
Endothelial keratoplasty 4, 5, 17, 21, 27, 228, 234, 235, 242244, 250, 262, 286, 309, 321, 325, 382, 429
evolution of 234
techniques 228, 272t
Endothelial layer 194
Endothelial microscopy 32
Endothelial rejection 101f, 148, 148f
Endothelial replacement 549
Endothelium 224f, 256, 272
Enucleation 30
Epidermolysis bullosa 409
Epikeratoplasty 7
Epithelial basement membrane dystrophy 520, 527
Epithelial bullae 333f
Epithelial defect 126, 500
following penetrating keratoplasty 126
fluorescein staining of 126f
recurrent 436
Epithelial downgrowth 7, 151
Epithelial inclusion 517
cysts 546
Epithelial ingrowth 132, 148, 148f, 241, 366
Epithelial stem cells, ex vivo expansion of 441
Epithelium 547
Erythema elevatum diutinum 467
Erythrocyte sedimentation rate 490
Escherichia coli 338
Ethylenediaminetetraacetic acid 482, 526
Excimer laser 155
ablation 436
phototherapeutic keratectomy 489
trephination 87
Extracapsular cataract extraction 306
Eye
bank 47, 53, 54, 54t, 55t, 58, 363
Association 24, 25, 43
evolution of 62
medical director 56
personnel and governance 54
setting up 53
Banking
Laws 40, 42, 43
medicolegal aspects of 40
decontamination 30
disease, allergic 149
donation
center 54, 54t, 55t
surgery 29
donor coordination 28
ectatic disorder of 386
globe fixation 72
preparation of 520
retrieval of 42
shield 75
speculum 67, 163
tissue, donation of 28, 30
Eyelids 514
management of 515
F
Femtosecond 180
anterior lamellar keratoplasty 180, 379
deep anterior lamellar keratoplasty 377
descemet
membrane endothelial keratoplasty 378, 378f
stripping automated endothelial keratoplasty 379
laser assisted
anterior lamellar keratoplasty 225, 397
deep lamellar descemet stripping automated endothelial keratoplasty 384f
deep lamellar endothelial keratoplasty 382, 383f
descemet stripping endothelial keratoplasty 6
endothelial keratoplasty 237
hemi-automated lamellar keratoplasty 368
ipsilateral rotational lamellar autokeratoplasty 397, 403
keratoplasty 374
laser enabled
descemetorhexis descemet membrane endothelial keratoplasty 6
keratoplasty 374f
laser technology 374, 380
penetrating keratoplasty 374, 375f
tuck-in penetrating keratoplasty 423
Fetal bovine serum 414
Fibrous ingrowth 132
Figure 8 ipsilateral rotational autokeratoplasty, technique of 401f
Flap retraction 546
Fleischer's cone 209
Flexible open-loop anterior chamber intraocular lens 316
Flieringa ring 68, 68f, 95f, 119, 163, 163f
Fogla corneal scissors 210
Fogla trifacet spatula 210
Four cardinal sutures, placement of 88
Four quadrant refractive map 20f
François central cloudy dystrophy 7
Fuchs’ dystrophy 10, 11, 18f, 283f, 304
Fuchs’ endothelial corneal dystrophy 286, 304, 313
Fuchs’ endothelial dystrophy 7, 152, 250, 280, 439
Fuchs’ superficial marginal keratitis 468, 489
Full thickness patch graft 393
Fundoscopy 101
Fundus evaluation 17, 142
Fungal 7, 489
infections 340
keratitis 104, 323, 333
demateaceous 182f
G
Gas permeable lenses 111
Gauze piece fixated eyeball 72
Gebauer microkeratome 166, 170f
Gelatinous drop-like dystrophy 519
Gene therapy 547
Gill's lamellar dissector 165, 166f
Gingival hyperplasia 105
Glare 526
Glaucoma 7, 135, 141, 143, 241, 510
congenital 7, 10, 323, 476
corneal grafting in 103
drainage devices 143
postkeratoplasty 140, 143
preexisting 91, 135
secondary 500
steroid-induced 366
surgery 287
Globe exposure, instruments for 67, 163
Globe supporting rings 68, 163
Goldmann applanation tonometry 142
Gonioplasty 315
Gonioscopy 18
assisted transluminal trabeculotomy 143
Graft
delivery 251
detachment 240, 295
failure 101f, 146, 149, 150, 275, 296, 367, 501
primary 128
secondary 146
fixation of 224
holder 166
host junction
configurations of 345
revision of 155, 155f
infection, postoperative 131b
inflammation 150
zoster-related 151
insertion 238
inversion of 120
preparation of 223, 274
rejection 128, 241, 296, 366, 500, 528
differential diagnosis of 150
preparation of 146
types of 146
staining 263
survival 254, 297, 368, 405
versus host disease 409
Granular corneal dystrophy 520, 524, 524f, 527
Granular dystrophy 7, 10, 362f
Grasping instruments 74, 166
Grieshaber-Franceschetti trephine 69
Groove and Peel
deep anterior lamellar keratoplasty 213
technique 213
Growth retardation 105
Guarded depth blades 257
Guarded diamond knife 166
Guided trephine system 72
Gundersen's flap 544, 546f
Gundersen's procedure 493
H
Handheld
disposable trephine 163
keratometer 75
trephines 69, 84, 85, 164f
Hanna's trephine system 71, 72, 72f
Health system 60
Hemi-automated lamellar keratoplasty 360362, 362f, 363, 367f, 368f
outcomes of 367
Hemorrhage 120
suprachoroidal 122
Hepatitis
B
surface antigen 26
virus, iatrogenic transmission of 26
C virus 26
Herpes simplex 105
interstitial keratitis 334f
keratitis 129, 323
virus 7, 141, 147, 204, 362, 439
disease 147
keratitis 150, 362, 367
Herpes zoster
ophthalmicus 11
virus inflammation 151
Herpetic corneal scar, central 204f
Herpetic eye disease study 147
Herpetic keratitis 10, 336, 506
Herpetic stromal disease 334f
Hessburg-Barron
punch 184
trephine 70f, 72, 86f, 164f, 223
Higher order aberration 242, 387, 463
High-resolution
anterior segment optical coherence tomography 454
ultrasound biomicroscopy 471
Hip necrosis, avascular 105
Horizon microkeratome system 365
Horizontal visible iris diameter 541
Horseshoe tear 290
Hospital cornea recovery programs 53, 60
Host
eye 396
preparation 371
trephine sizing 83
Hot eyes 104, 395
Human amniotic membrane 408, 412, 435
Human corneal
endothelial cells 549f
tissue 58
Human eye bank eye 188f
Human immunodeficiency virus 26
Human organ
and tissue Act, transplantation of 40
transplant Act 43
Human tissue engineered cornea 550
Hurricane keratopathy 133, 133f
Hyaloid face intact 315
Hybrid lenses 114
Hydrophilic bandage contact lens 490
Hydrops 476
chronic 425f
management of acute 477
Hydroxypropyl methylcellulose 200f
Hyperglycemia 105
Hypermetropia 152
Hyperopia 242
Hyperopic shift 526
Hyperosmotic agents 142
Hypertension 105
intraocular 141
ocular 140
Hyphema 128, 129
Hypogammaglobulinemia 489
Hypothermic corneal storage 33
Hypothesis 484
ulcerative 484
Hypotony 501
I
Immune complexes 490
Immune mediated corneal melt 489
Immunohistochemistry 474
Implantable collamer lens 157
implantation 157f
Implantation 515
In vivo confocal microscopy 467
Indian Human Organs Transplantation Act 44
Indirect ophthalmoscopy 520
Infections 105, 172, 204, 527
bacterial 25, 27
control 80
fungal 25, 27
viral 25, 26
Infectious crystalline keratopathy 7, 132
Infectious keratitis 8f, 9f, 50, 241, 361, 435, 436, 438, 438f
over full-thickness graft 130f
scar, contact lens associated 362f
Inferior corneal ectasia 372f
Inferonasal corneoiridic scar, slit-lamp image of 481f
Inflammation 408
Injury, nonpenetrating 323
Inlay graft 442
Interface infections 366
International Laws on Eye Banking 40
Interrupted sutures 94, 220
Intracameral air injection 425f
Intracapsular cataract extraction 306
Intracorneal ring segment 156, 459, 519, 527
Intraepithelial corneoconjunctival carcinoma, recurrent 520
Intraocular lens 15, 270f, 273f275f, 280, 303, 312, 313, 395, 478
evaluation of 313
implantation 316
power calculation 305, 314
selection of 281
Intraocular pressure 17, 81, 99, 100, 140, 210, 221, 243, 294, 366, 374, 395, 488, 497, 506
control 81, 339
elevation 296
high 129
low 124
Intraocular procedures 157
Intraocular sulfur hexafluoride 295
Intraoperative optical coherence tomography 294f, 323f, 326f, 328f, 352, 482, 482f, 485
Intraoperative ultrasonic pachymetry 218
Intrastromal crescentic lamellar keratoplasty 350
Intrastromal ring segment, implantation of 523
Intravesical bacille calmette-guérin injection 489
Intrinsic eye disease 27
IOWA PK press corneal punch 73
Ipsilateral rotational
autograft, procedure of 402f
autokeratoplasty 400, 404f, 405
Iridocorneal endothelial syndrome 7, 10, 250
Iridocyclitis 124
Iris 16, 395
abscission 390f
color 541
incarceration 122, 123
lens diaphragm 121
forward movement of 129
painted black pupil 539f
procedures 325
rim enhancer prosthetic lens 540f
sutured posterior chamber intraocular lens 317
Irrigation cannulas 75
Isoexpansile perfluoropropane gas, intracameral injection of 464f
K
Kaufmann corneal cutting block 72
Kaye's dots 148
Kelman-Mcpherson forceps 316
Keratic precipitates 101, 296
Keratinization 11f
Keratitis 481f, 483, 520
active 10
bacterial 104, 182f, 323, 332
exposure 7
filamentary 127, 436
infectious 8f, 9f, 50, 241, 361, 435, 436, 438, 438f
interface infectious 335
interstitial 10, 323
neurotrophic 50, 323, 436, 489
post-microbial 7
secondary microbial 150
Keratoconjunctivitis
atopic 453
epidemic 7
sicca 7, 409
Keratoconus 10, 20f, 149, 175, 181f, 196f, 198, 203, 221f, 223, 323, 356f, 386, 419, 454, 474, 475
advanced 223
anterior 7
nodules 520
posterior 7, 453, 475
post-penetrating keratoplasty, progression of 223, 226f
Keratoglobus 7, 10, 223, 423, 425f, 453, 455, 474, 475, 478
acquired 474
congenital 474
management of 478
Keratolimbal allograft 409, 413t
Keratolysis 528
Keratomalacia 7, 480, 483
advanced 489
Keratometry 18, 105, 140, 247, 314f, 328, 344f, 362, 431, 492
Keratopathy
neuroparalytic 7
neurotrophic 7
Keratoplasty 4, 78, 303
autorotational 400, 482
bilateral penetrating 525f
central
lamellar 462f
penetrating 357f
compressive C-shaped 350, 371, 372, 372f
decagonal 346
reconstructive 8
technique 242
Keratoprosthesis 505, 509, 547
design of 505
implantation of 436
procedures 509b
setup 509
surgery 506b
temporary 309
types of 505
Keratotomy, astigmatic 134, 153, 154f
Khodadoust endothelial rejection line 148f
King's clamp 164, 165f
Kratz-Barraquer eye speculum 67
Krolman viewing chamber 288f
Krüppel associated-box domain 550
L
Lagophthalmos 103
neuroparalytic keratitis-associated 489
Lamellar dissection 218, 219f, 256
Lamellar dissector 165, 218, 257f
Lamellar keratoplasty 152, 161, 163, 172, 209, 223, 226f, 321, 338, 358f, 395, 400, 409, 462f, 492, 497, 536
future of 190
postoperative 357f
Lamellar patch graft 392, 392f
Lamellar pocket method 536
Laminar flow hood 56f
Langerhans cells 467
Laplace law 488
Large diameter
anterior lamellar keratoplasty 419
deep anterior lamellar keratoplasty 203
lamellar keratoplasty 421
penetrating keratoplasty 477
Laser 49, 142
assisted subepithelial keratectomy 155
in situ keratomileusis 81, 134, 156, 184, 212, 519, 520
flaps 374
interferometry 19, 314
iridotomy 142
trabeculoplasty 143
Latanoprost 142
Lattice corneal dystrophy 181f, 520, 524, 525f, 527
bilateral 525f
Lattice dystrophy 7, 10, 367f
Lattice stromal dystrophy 467
Law, adoption of 44
Leber's congenital amaurosis 474
Lens 17, 395
materials 111
overall diameter 111
power 112
size of 113
thickness 112
Leukomas 172
Leukopenia 105
Lid speculum, insertion of 81
Lieberman
eye speculum 67, 282
gravity action punch 73
single point cutter 71
Light microscopy 33
Limbal
corneal dermoid 328f
epithelial transplant 412
graft, harvesting of 410
insufficiency 421
stem cell 407, 412
deficiency 407f, 408, 408f, 409f, 413t, 414, 415f, 419, 435, 436, 439
disorder 493
transplantation 12, 407, 408410, 411f, 415f
Logmar visual acuity, postoperative 175t
Low vision 50
Lower order aberrations 152
Lubricants 91
M
Macular corneal dystrophy 7, 10, 22f, 520, 526f
Maculopathy 136
Maddox rod test 314
Major histocompatibility complex 146
Malignancy 25, 27
Maloney keratometer 75
Manual deep lamellar keratoplasty 49
Manual descemet stripping endothelial keratoplasty graft preparation, complications of 261
Manual dissection technique 259f
Manual donor dissection 235
Manual lamellar dissection 236f, 258, 363
Marfan's syndrome 474
Matrix metalloproteinases 474, 509
McNeill-Goldman
blepharostat 119
ring 68, 68f, 163, 163f
McPherson forceps 166, 168f, 218
Mechanized corneal trephine 70, 164
Megalocornea 475
Melles manual deep anterior lamellar keratoplasty 191f
surgical technique 186
Melles spatula set 187
Melles technique 186
Mental changes 105
Methylprednisolone 106
Microbial keratitis 7, 130, 150, 333f, 489
Microcystic epithelial edema 463f
Microkeratome 177, 236f
automated 318
donor dissection 236
head applanation lenses 179f
Microkeratron trephine 70
Micrometer 218
Micropuncture device 536f
Microscope integrated optical coherence tomography 177, 427, 430, 431
Microvitreoretinal blade 219
Middle east respiratory syndrome coronavirus 26
Mini curve needles 78
Minimal inhibitory concentration 337
Minimum corneal thickness 457
Minimum residual stromal bed thickness 519, 520
Miniscleral contact lens 113f
Miniscleral design 113
Miotics 142
Mitomycin C 226f, 522
Monofilament nylon sutures 200, 462f
Mooren's ulcer 7, 338, 348, 457, 468, 489
Moria artificial anterior chamber 165f
Moria automated lamellar therapeutic keratoplasty system 228, 281, 364
microkeratome of 364f
Moria punch block 168
Moxifloxacin 256
Mucopolysaccharidosis 323
Mucous membrane pemphigoid 409, 409f, 506, 513
Multiple corneal foreign bodies 182f
Multiple endocrine deficiency 409
Multiple graft failures 10
Multiple intralamellar dissection planes 365
Mushroom keratoplasty 344, 344f
Mycobacterium fortuitum 333
Mycophenolate mofetil 106
Myopia 152
Myopic shift 527
N
National organ transplant act 40
National Program for Control of Blindness and Visual Impairment 43, 56
Needles 78
holder 218
Neodymium-doped yttrium aluminum garnet laser 15, 516
Nerve fiber density 408f
Neuroparalytic disease 10
Neurotrophic corneal perforation 337
Neurotrophic disease 10
Nodular corneal degeneration post-debridement 436
Noncircular corneal transplantation, technique of 345, 348
Non-proliferative diabetic retinopathy, bilateral severe 525f
Nonsteroidal anti-inflammatory drugs 240
Nontoothed forceps 74
Novel surgical techniques 547, 548
Nucleic acid testing 29
Nutritional deficiencies 7, 480
Nylon 77
sutures 77
O
Obstructive sleep apnea 453
Obturator-guided conventional circular trephine 69f
Ocular burns, severe 419
Ocular cicatricial pemphigoid 11f, 489, 506
Ocular discomfort 105
Ocular examination 16, 280
Ocular herpes simplex virus disease 105
Ocular hypertension, secondary microbial 140
Ocular pemphigoid 10
Ocular rosacea 489
Ocular surface 280
diseases 419, 421
corneal grafting in 102
severe 407
disorders, management of 414t
ecosystem, prosthetic replacement of 459, 477
preparation of 514
squamous neoplasia 414
Opacity
congenital 7
size of 400
types of 400
Open sky
extracapsular cataract extraction 307f
intraocular lens implantation 308f
Ophthalmia neonatorum 323
Ophthalmic viscosurgical device 304
Optic zone 111
Optical coherence tomography 153, 186, 203, 217, 265, 321, 327f, 362f, 363, 368f
Optical correction 329
Optical grade transplantable cornea, allocation of 47
Optical iridectomy 481, 534f
indications of 531
Optical keratoplasty 8
Optical sector iridectomy 531, 532
Oral corticosteroids, role of 149
Organ culture storage 34
Original corneal pathology, recurrence of 136, 528
Oropharyngeal commensals 489
Osteogenesis imperfecta 474
Osteo-keratoprosthesis 508
Osteo-odonto keratoprosthesis 548
modified 508
Osteoporosis 105
Overlay patch 441, 445
P
Pachymetry 18
Pain, degree of 100
Painful bullous keratopathy 435
Paired arcuate keratotomies 154f
Palladium oxide 535
Paraffin block 218
Parkinson's disease 337
Parotid carcinoma, postsurgical excision of 489
Partial limbal stem cell deficiency 439, 445
Partial thickness
crescentic-wedge resection 462f
trephination 214f
Patch graft 389, 436, 491, 492
following dermoid excision 391f
Paton spatula 71f, 88f, 166, 168f
Paufique's knife 165
Paufique's lamellar dissector 165f
Pediatric corneal transplant surgery 321, 323b
Pediatric eye undergoing penetrating keratoplasty 433f
Pediatric keratoplasty 431
Pellucid like keratoconus 454
Pellucid marginal corneal degeneration 223, 355, 356f358f
etiology of 453
Pellucid marginal degeneration 9f, 10, 217, 219f, 220f, 221f, 223, 225f, 348, 349, 371, 453, 454, 454f, 455, 457, 457f, 461, 463f, 475
advanced 356f
Penetrating keratoplasty 7, 7b, 10, 10b, 13, 24, 49, 49t, 50, 67, 77, 80, 91, 94, 95f, 96f, 99, 101t, 105t, 110f, 117, 140, 152, 154f, 157f, 172, 184, 186, 194, 200, 203, 209, 234, 242, 256, 268, 280, 287, 287f, 303, 312, 313, 321, 324, 343, 360, 374, 378f, 382, 386, 395, 400, 409, 423, 424f, 427, 477, 481, 486, 491, 492, 497, 547
complications of 119
indications of 7
mushroom shaped 420
outcomes of 7
procedures 242t
technique of 80
Pentacam topography maps 456f
Peptic ulcer 105
Perforation 437
Peripheral anterior synechiae 20, 100, 135, 141, 141f, 236, 313
Peripheral buttonhole iridectomy 499f
Peripheral cornea 223, 240f
Peripheral corneal
disorders 348
ectasias, advanced 371
involvement 225
pathologies, surgical management of 348
thinning 475f
ulcer 460f
Peripheral crescentic lamellar keratoplasty 357f
Peripheral curve systems 111
Peripheral fit 113
Peripheral iridectomy 252, 325, 499
Peripheral pocket formation 174f
Peripheral ulcerative keratitis 348, 349, 467
Persistent epithelial defect 126b, 413, 436, 437f
Personal protective equipment 30
Peter's anomaly 7, 323, 485
Petri dish 230
Phacoemulsification 282, 283f, 306, 309
Phagocytosis 466
Phakic eye 292f
Phlyctenular inflammation 390f
Photorefractive keratectomy 81, 134, 155, 185f, 436, 519, 520
Phototherapeutic keratectomy 185, 435, 436, 519, 522, 526, 528
complications of 526
indications of 520b
outcomes of 522
Pierse-Hoskin's forceps 74, 166, 167f, 218
Piggyback lenses 114
Pigment dispersion syndrome 135
Pilocarpine 142
Plaque radiation therapy 436
Plastic drape template technique 345, 436
Platelet-rich fibrin 492
membrane grafting 491, 492
Pneumodescemetopexy 464f
Polack forceps 74f
Polychondritis 349
Polydioxanone suture 77
Polyester 77
Polyhexamethylene biguanide 105
Polymerase chain reaction 27
Polymethyl methacrylate 459, 505, 547
Polypropylene 77
Post infectious severe corneal stromal 9f
Postcorneal dermoid excision 391
Post-Descemet stripping endothelial keratoplasty 526
Posterior capsular tear 121
Posterior chamber intraocular lens 8, 257, 316, 317
implant 312f
insertion 307
Posterior lamellar keratoplasty 4, 234, 235f, 242, 247, 318, 382
Posterior polymorphous dystrophy 7, 250, 323
Posterior segment evaluation 497, 520
Posterior stroma complex 385f
Postexcimer laser corneal haze 386
Postinflammatory staphyloma 393f
Postkeratoplasty 520
atopic keratoscleritis 366
contact lens fitting 108
corneal ectasia 225
total cataract 133f
Postlamellar graft 537f
Post-laser
in situ keratomileusis keratitis 520
surgery 7
Postoperative cylinder diopters 242
Post-penetrating keratoplasty
ectasia 226f
glaucoma 140, 141f
incidence of 140
Post-photorefractive keratectomy 360
corneal haze 520
Postrefractive surgery 7
complications 362, 520, 526
corneal ectasia 223
Postsurgical inflammation 151
Post-traumatic
corneal perforations 480
descemetocele 489
Post-viral keratitis 7
Potential acuity meter measurement 363
Povidone iodine 30
antiseptic 257
readily inactivates coronavirus 26
Pre-Descemet endothelial keratoplasty 5, 248, 262, 264, 269f, 270f, 272, 272f275f, 319
complications of 274
surgical procedure of 270f, 271f
Pre-Descemet membrane 262
Prefit examination 113, 540
Preoperative cylinder diopters 242
Preoperative pseudophakic bullous keratopathy 268f
Prick and print technique 352
Primary pterygium 520
excision 414
Print and prick keratoplasty 346
Prion disease 25
Program implementation plan 57
Propamidine isethionate 105
Prostaglandin analogs 142
Prosthetic
contact lens 539, 542f
use of 540
fitting procedure 541
lens
care 542
options 539
matching process 541
Protein calorie malnutrition 489
Proteolytic enzymes, role of 488
Pseudomembrane formation 9f
Pseudomonas 489
aeruginosa 331, 332
keratitis 332f, 438
Pseudophakia 315
Pseudophakic
bullous keratopathy 8f, 10, 250, 269f, 270f, 272f, 312, 312f, 314f, 333f, 383f, 430
corneal edema 7
eyes 135
Pterygium 436, 526
excision 391, 489
recurrent 520
Ptosis 546
Pull-through techniques 239
Punctate keratopathy 105
Pupil
constriction of 282
size problems 542
Pupillary block 129, 275
glaucoma 129
Pupillary management 81
Pupilloplasty 316, 325
Push-in techniques 239
Q
Qualitative keratometers 75
Quality-adjusted life year 517
R
Radial keratotomy 82f, 489
Radiation 409
therapy, high-dose 489
Raised intraocular pressure 241
Recipient cornea
dissection, instruments for 163
preparation 424
trephination 306
Reconstructive lamellar patch graft 390
Recording device 51f
Recurrent corneal erosions 436, 520, 524
Refraction 18, 520
Refractive error following keratoplasty, management of 152
Refractive outcomes 296, 420
Refractive surgery 155, 368f
Refractive technologies 365
Regenerative medicine 547, 549
Reis-Bücklers corneal dystrophy 520, 523f
Rejection post lamellar keratoplasty 150
Residual viscoelastic anterior chamber 129
Retinal evaluation 314
Retinal surgery, concomitant 325
Retroprosthetic membrane 507, 509, 510f, 516
Revised Uniform Anatomical Gift Act 41
Rheumatoid arthritis 467, 489
Rho-associated kinase inhibitor 243, 549
Rhodotorula rubra 489
Ribonucleic acid 26
Rigid gas permeable 110f, 153, 471
contact lens 110f
Ring-shaped lamellar keratoplasty 352
Rosacea 389f
Rose-K lens 112
advanced models of 113
Rose-K post-graft fitting procedure 113
Rose-K2 lens 113
Rotational corneal transplantation 398f
Rothia dentocariosa 489
Rothman-Gilbard corneal punch 73, 84
Routine Peribulbar block 257
Rubinstein-Taybi syndrome 474
Running suture, adjustment of 153f
Rupture 7
Rycroft cannula 199, 201f
S
S stamp 232, 232f
Salzmann nodular degeneration 181, 181f, 363, 520, 523f
Sanders-Retzlaff-Kraff formula 314
Scheimpflug imaging 19, 454, 468
system 19f
Schirmer's test 217
Schlemm's canal endothelial cells 243
Schnyder corneal dystrophy 7, 520
Scleral fixated posterior chamber intraocular lens 317
Scleral fixation ring 119
placement of 82
Scleral patch graft 391, 393
Scleral perforation 119
Scleral tunnel 309
incision 282f
Sclerocornea 7, 323
Sclerocorneal intrastromal lamellar keratoplasty 350
Scleroderma 453
Sclerokeratoplasty 486, 486f, 496, 497, 501
outcomes of 501
penetrating 496
Scleromalacia perforans 391
Severe acute respiratory syndrome 26
Shallow anterior chamber 122, 123
Shifting bubble sign 198
Shock, ciliary 124
Silicone
hydrogel lenses 113
oil
filled eyes 506
keratopathy 7
Simcoe's irrigation-aspiration cannula 75f
Simple limbal epithelial cell transplantation 12, 408
Single continuous suture 89, 94, 97
Single interrupted suture technique 94, 96, 97
Single pass technique 237
Single point cutting corneal trephines 71
Sinskey hook 240, 252, 267f, 376, 385f
modified 238, 238f
reverse 257
Sjogren's syndrome 7, 409, 453, 490, 513
Skin
biopsy punches 71, 71f, 164, 164f
retraction, postoperative appearance of 517f
Slit-lamp
biomicroscopic
evaluation 520
examination 459f
biomicroscopy 16, 55f, 463f
evaluation 31
examination 100, 490
microscopy 468
Small bubble technique 217
Small incision
cataract surgery 257
lenticule extraction 156, 225, 374
Smooth graft-host interface 180f
Snellen's chart 16
Sodium hyaluronate 257
Soemmering's ring 317
Soft contact lens 109
fitting 113
Spatula 74, 167f
Spectacles 459
Specular count 395
Specular microscopy 18f, 32, 211f
Speculum, adjustable 67
Spheroidal degeneration 520
S-stamp 168, 170f
Stable neurotrophic ulcer 336f
Staphyloma 484
anterior 484, 485f, 486f, 487, 497
Sterile corneal stromal thinning 437
Sterile melts 509
Steroids
long-term use of 135
systemic 105
topical 142
Steven-Johnson syndrome 10, 11f, 323, 407, 409, 436, 438f, 441, 442f, 489, 506, 508f, 509, 510f, 513
Straiko injector 171
Straylight meter 18
Streptococcus pyogenes 550
Stripping Descemet's membrane 238f
Stroma, posterior 199f, 224f
Stromal corneal dystrophies 7
Stromal defect 435, 436
Stromal dystrophy 520
congenital hereditary 323
recurrent 7
Stromal keratocytes 146
Stromal scar, anterior 368f
Subepithelial cryoglobulin deposits 520
Subepithelial infiltrates 148f
Suction fixation corneal trephine 70, 85, 164
Suction trephine 85
Sulcus, ciliary 317
Superficial anterior corneal scars, management of 225
Superficial anterior lamellar keratoplasty 184, 185, 185f
microkeratome-assisted 184, 309
Superficial keratectomy 435, 440f, 443, 444f
Superficial lamella 173f
Superior pellucid marginal corneal degeneration 356f
Superior peripheral ulcerative keratitis 468f
Surgery, timing of 322
Suture
alignment markings 375
induced vascularization 125f
materials 77
types of 77t
removal 78, 201, 329
selective removal of 153
tension, adjustment of 308
Sutureless
amniotic membrane transplantation 436f
and glueless technique, modified 225
anterior lamellar keratoplasty 169f
transplantation, surgical steps of 444f
Suturing graft 308
Suturing technique 94, 188
advantages of 94t
disadvantages of 94t
Symblepharon formation 11f
Symptomatic bullous keratopathy 439, 520
Synechiae, lysis of 91
Systemic corticosteroid sparing immunosuppression 147
Systemic lupus erythematosus 349, 489
Systemic therapy 189
Szurman Descemet's membrane endothelial keratoplasty
marker 230, 230f
preparation spatula 231, 231f
T
Tacrolimus 106
Tarsorrhaphy, temporary 127
Tattooing, methods of 534
Tear film status 18
Tectonic corneal graft 9f
Tectonic Descemet stripping automated endothelial keratoplasty 277
Tectonic keratoplasty 8, 277, 331
Tectonic patch graft 389, 392
indications of 391b
Tectonic surgery 471
Teflon block 71f, 229
Tenon's patch graft 493
Tenotomy 73
Terrien marginal degeneration 7, 223, 348, 371, 457, 459f, 466, 467, 468f471f
Therapeutic keratoplasty 9, 331333, 335
indications for 331
visual prognosis for 340
Therapeutic penetrating keratoplasties, postoperative management of 339
Therapeutic soft contact lens fitting 114
Thermal burns 408, 436
Thiel-Behnke corneal dystrophy 520, 528
Thin lenticule descemet stripping automated endothelial keratoplasty 247
Thrombocytopenia 105
Tightening iris diaphragm 325
Tissue
adhesives 491, 492
advantages over 391
engineered cornea 548
failure, primary 7
loss 274
matching 147
retrieval considerations 31t
superficial lamella of 173f
Titanium needle holder 74f
T-lymphotropic virus 29
Tonometry 142
Tooke's knife 165, 165f
Toothed forceps 74
Top-hat keratoplasty 343
Topical therapy 189, 490
Topographic neutralization technique 361
Topography guided photorefractive keratectomy 360
Topography measurements 540
Toric intraocular lenses 153
Toxic anterior segment syndrome 236
Toxic epidermal necrolysis 436, 441, 513
Toxicity 105
Trabeculectomy 143, 322
Trachoma 7
Trachomatous scarring 520
Transepithelial phototherapeutic keratectomy 521
Transplantation 410
Trauma 7, 204, 304, 408, 483
Traumatic irreparable corneal tissue loss 391
Traumatic opacity 7
Travoprost 142
Trephine
blade 218
handle 69f
noncontact 72, 164
recipient cornea 85, 70
types of 69
Treponema pallidum 349
Trial lens method 541
Trichiasis 103
Tridimensional cornea scaffold models 548
Troutman corneal punch 72
Troutman scissors 73f, 167f
Tube shunt implantation 243
Tuck in lamellar keratoplasty 49, 218, 223, 225, 226f, 355, 357, 358f, 359f, 460, 477
crescentic 350, 355
C-shaped 355
evaluation of 225
Tuck in penetrating keratoplasty 345, 345f
Tudor Thomas stand 72
Tumors 172, 436
extensive 497
Two-piece microkeratome-assisted mushroom-shaped penetrating keratoplasty 420f
Two-point discrimination test 314
U
Ulcer, neurotrophic 336f
Ulcerative keratitis, noninfectious 7
Ultrabiomicroscopy 141f
Ultrasonic intraoperative pachymeter 218
Ultrasonography 22, 520
Ultrasound biomicroscope 20, 20f, 313, 321, 432, 481, 506
Ultrathin Descemet stripping automated endothelial keratoplasty 250, 252
Umbilical cord patch 491, 492
transplantation 492
Uncorrected visual acuity 155, 175, 221, 362
Universal metallic wire speculum 163f
Universal trephine 69
Urrets-Zavalia syndrome 91, 129
Utrata forceps 257
Uveitis 7, 129, 483
glaucoma hyphema 313
V
Vajpayee's corneal marker 68, 68f
Vajpayee's modified keratoplasty suture marker 171f
Valacyclovir 105
Vannas scissors 174, 174f, 224f, 317, 499f
Varicella zoster virus 7
Vernal keratoconjunctivitis 409, 467
Videokeratography 395
Viral endotheliitis 280
Viral keratitis 7, 304f
reactivation of 528
Vision enhancement surgeries 471
Visual acuity 16, 100, 367, 398, 413, 490, 541
Visual evoked response 22, 305, 321, 395, 481
Visual outcomes 242, 253, 296, 420
Vitamin A deficiency 480
Vitrectomy 91, 315
Vitreocorneal touch 7
Vitreoretinal problems 136
Vitreous pressure 119
Vitreous prolapse 121
W
Wegener's granulomatosis 349
Weight gain 105
Wescott scissors 292f
Wire speculum 67f, 218
Wound
creation of 282, 283
dehiscence 124
causes of 124b
healing 339, 376, 378
leak 122, 124
causes of 123b
leakage, check for 90
strength 374
X
Xeroderma pigmentosum 409
Y
Yttrium aluminum garnet
laser capsulotomy 310
peripheral iridotomy 481
Z
Zigzag keratoplasty 344, 344f
×
Chapter Notes

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CORNEAL TRANSPLANTATION
VIDEO CONTENTS
Penetrating Keratoplasty
Video 1: Technique of Penetrating Keratoplasty (Chapter 11)
Video 2: Complications of Penetrating Keratoplasty (Management of Expulsive Hemorrhage) (Chapter 15)
Lamellar Keratoplasty
A: Anterior Lamellar Keratoplasty
Video 3: Dry Manual Technique for Deep Anterior Lamellar Keratoplasty (Chapter 20)
Video 4: Superficial Anterior Lamellar Keratoplasty (Chapter 22)
Video 5: Deep Anterior Lamellar Keratoplasty: Big Bubble Technique (Chapter 24)
Video 6: Deep Anterior Lamellar Keratoplasty: Double Bubble Technique (Chapter 25)
Video 7: Large Diameter Deep Anterior Lamellar Keratoplasty (Chapter 26)
Video 8: Diamond Knife-assisted Deep Anterior Lamellar Keratoplasty (Chapter 29)
Video 9: Tuck-in Lamellar Keratoplasty (Chapter 30)
B: Posterior Lamellar Keratoplasty
Video 10: Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty (Chapter 34)
Video 11: Pre-Descemet's Endothelial Keratoplasty Combined with Glued Intraocular Lens Implantation and Single Pass 4 throw Pupilloplasty (Chapter 36)
Video 12: Descemet's Stripping Automated Endothelial Keratoplasty Triple Procedure (Chapter 38)
Specific Techniques in Corneal Transplantation
Video 13: Penetrating Keratoplasty for Aphakic and Pseudophakic Bullous Keratopathy (Chapter 41)
Video 14: Pediatric Keratoplasty (Limbal Dermoid excision) (Chapter 42)
Video 15: Therapeutic Penetrating Keratoplasty (Chapter 43)
Video 16: “Copy and Fix” Technique of Harvesting Grafts (Chapter 45)
Video 17: Hemi-automated Lamellar Keratoplasty (Chapter 47)
Femtosecond Laser-assisted Keratoplasty (Chapter 49)
Video 18: Femtosecond Mushroom-shaped Keratoplasty (PK/DALK)—Recipient Preparation
Video 19: Femtosecond Mushroom-shaped Keratoplasty (PK/DALK)—Donor Preparation
Video 20: Femtosecond Laser-assisted Deep Anterior Lamellar Keratoplasty
Video 21: Femtosecond Laser-assisted Descemetorhexis
Video 22: Technique of Descemet Stripping after Femtosecond Laser-assisted Descemetorhexis
Tectonic Patch Grafts (Chapter 52)
Video 23: Tectonic Patch Graft for Focal Corneal Infiltrates
Video 24: Tectonic Patch Graft for Corneal Fistula
Video 25: Tectonic Patch Graft for Post-cataract Surgery Tunnel Infiltrate
Video 26: Tectonic Patch Graft for Peripheral Corneal Melt
Video 27: Autorotational Keratoplasty (Chapter 54)
Video 28: Simple Limbal Epithelial Transplantation (Chapter 55)
Microscope-integrated Intraoperative Optical Coherence Tomography (IOCT) Guided Keratoplasty (Chapter 58)
Video 29: IOCT Guided Big Bubble Deep Anterior Lamellar Keratoplasty
Video 30: IOCT Guided Deep Anterior Lamellar Keratoplasty: Layer by Layer Dissection
Video 31: IOCT Guided Descemet's Stripping Automated Endothelial Keratoplasty
Video 32: IOCT Guided Descemet's Membrane Endothelial Keratoplasty
Video 33: IOCT Guided Re-bubbling
Video 34: IOCT guided Sutureless Patch Graft
Miscellaneous
Video 35: Lamellar Keratoplasty with Interface Tattooing (Chapter 71)
Video 36: Implantation of Bio-engineered Cornea (Chapter 74)
Scan QR code to access the videos
CORNEAL TRANSPLANTATION
Third Edition
Editors Namrata Sharma MD FRCOphth FRCSEd Professor of Ophthalmology Cataract, Cornea and Refractive Surgery Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Ritu Nagpal MD FLVPEI (Cornea) Senior Research Associate Cataract, Cornea and Refractive Surgery Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Rasik B Vajpayee MS FRCSEd FRANZCO Professor of Ophthalmology Cornea, Cataract and Refractive Surgery Services Vision Eye Institute, Melbourne Royal Victorian Eye and Ear Hospital University of Melbourne Melbourne, Australia Forewords Hugh R Taylor Mark J Mannis Jorge L Alió
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© 2023, Jaypee Brothers Medical Publishers
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
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Corneal Transplantation
First Edition: 2002
Second Edition: 2010
Third Edition: 2023
9789389587227
Printed at
To my respectable parents, Dr Ramesh C Sharma and Mrs Maitreyi Pushpa, my husband, Dr Subhash Chandra and my beloved daughter, Vasavdatta
–Namrata Sharma
To my mentors, who taught me the art of corneal transplantation and my ever supportive family
–Ritu Nagpal
To my wife, Madhu and my dearly loved children, Mihika and Shubhankar
–Rasik B Vajpayee
Contributors Foreword
What an exciting book? It has been written by a range of surgeons who really enjoy what they do, they do it so well, and they love sharing their skills and experiences. They are all leaders globally and in their own specific subspecialty areas.
The book is totally comprehensive. Sections start with the instruments you need for a particular procedure. Then the procedure is clearly laid out with many figures and excellent photographs. If complications do occur, their management is also clearly described and discussed. The expertise and the experience that has been captured in these chapters is truly remarkable.
The first edition of this book was written in 2002 and the second edition in 2010. As so clearly shown in the book, corneal transplantation surgery has undergone a remarkable evolution over the last few decades. Previous corneal transplantation predominantly consisted of penetrating keratoplasty, lamellar keratoplasty was an unusual procedure. How different things are today? In addition to the wonderful and detailed chapters on penetrating keratoplasty, this book describes in detail some 21 different lamellar transplantation surgical techniques with clear descriptions and explanations of particular benefits of the different variations.
The book also covers the whole range of corneal transplantation surgeries and treatment options. Other areas include limbal stem cell and buccal mucosal grafts, keratoprosthesis, and prosthetic contact lenses. Of course, it also covers eye banking, the basis for all transplantation surgeries. What a treasure trove and an educational experience this book provides.
A foreword does not need to be lengthy, but I hope that I have been able to convey the breadth, authority and comprehensiveness of the coverage of this rapidly progressing area. This is a must-have book for those learning about corneal transplantation. But also for those who are already corneal surgeons who can refine and improve their own surgery with the wonderful, clear and up-to-date descriptions given by this amazing group of world experts.
Hugh R Taylor
AC LLD (Hon) MD FAHMS FRANZCO
Past President
The International Council of Ophthalmology
Melbourne Laureate Professor and Harold Mitchell Chair of Indigenous Eye Health
Melbourne School of Population and Global Health
University of Melbourne
Melbourne, Australia
Foreword
The last three decades have witnessed a dramatic evolution in corneal transplantation. This evolution—indeed, a revolution in the surgical approaches to corneal diseases—has occurred based on an enhanced understanding of corneal structure, biology, and immunology. Our increased understanding of how the cornea works has led to a panoply of procedural approaches that are layer- and disease entity-specific. These focused surgical approaches provide a new repertoire of surgical procedures for the contemporary corneal surgeon.
In this volume, the editors have collected a wealth of knowledge and experience to provide the modern corneal surgeon with clinically pragmatic information in virtually every aspect of keratoplasty.
The text begins appropriately at the beginning—with the critical role of eye banking to the practice of keratoplasty. Unique in ophthalmology, the cornea subspecialty relies on the eye-banking system for its surgical success. The ever increasing and essential role of the eye bank in corneal surgery is outlined in detail.
The editors then move through the details of penetrating keratoplasty in all of its manifestations: indications, techniques, follow-up, and complication management. From there, the book concentrates on selective, layer-based keratoplasty in all its surgical variations. Tectonic and therapeutic keratoplasty, disease-specific surgical approaches, shaped keratoplasty, contact lens applications, prosthokeratoplasty and keratopigmentation techniques are all discussed in practical detail.
There are few texts of this scope in the modern ophthalmic library, and this very comprehensive text will serve as a distinctly useful tool for residents, fellows, and practitioners at every stage of their careers. It is a truly comprehensive manual on keratoplasty, and I am confident that this volume will serve the rapidly evolving field of keratoplasty for decades to come.
Mark J Mannis
MD FACS
Professor and Chair
Department of Ophthalmology and Vision Science
University of California
Davis, California, USA
Foreword
Corneal transplantation has evolved in the last decades into a sophisticated series of surgical techniques aiming to solve the different causes of corneal blindness. Cornea, as an ophthalmic subspecialty, has evolved accordingly requiring higher skills and a longer and deeper level of study and training, which are included in the cornea fellowship programs. However, the cornea specialist is frequently involved in other areas of Ophthalmology, but corneal surgery is the main motivation behind all of them. Even though we might also dedicate part of our practice to other fields such as refractive surgery, cataract or glaucoma, it is when we face a challenging cornea case that our medical spirit really awakens and we stretch our brains to solve the most challenging cases, requiring both experience and also sometimes “art” and inspiration to improvise a solution for those cases whose characteristics make them unique. To achieve this, the first thing a surgeon needs is knowledge, acquired from intense study that always involves the first step of any learning curve: study, observe, and finally practice. This book aims to provide the necessary material for this first step of learning curve, a reference book the reader can use as baseline knowledge to start their training in corneal transplantation.
This subspecialized area of ophthalmology has seen incredible progress in the last two decades with the introduction of lamellar keratoplasty techniques, thanks to the outstanding work of some colleagues who will be remembered in the history of ophthalmology and are also the authors in this book. The introduction of lamellar keratoplasty techniques has allowed us to significantly and progressively improve our visual outcomes and graft survival with progressively less invasive techniques. However, we should remember that there is still space for the old keratoplasty techniques, and classical surgeries (such as penetrating keratoplasty or limbal autografts among others) which must not be forgotten, since we still need to use them regularly in our practice. In this scenario, with the current book the reader will be able to have access to the old (but still valid) knowledge and the new techniques, learning from the classical keratoplasty techniques, including something as basic and critical as graft suturing, ending with an overview of the most modern lamellar keratoplasty techniques.
Despite the fact that in the last few years, with the advent of DMEK we have reached a new threshold, exciting years are still ahead with the standardization and introduction of new cellular therapies and regenerative medicine techniques in real clinical practice, that are expected to change the field of corneal grafting in the next two decades.
But we do expect even larger advances in the future, as topics such as genomics and regenerating procedures and new technologies will further widen the broad spectrum of surgical techniques and corneal therapies for the benefit of the patients affected by corneal diseases. The Cornea Specialist faces an exciting future that will be in part announced in the pages of this book.
We congratulate the Editors and Co-Authors of the splendid book for their dedication and success in providing medical education in this area.
Jorge L Alió MD PhD FEBO
Jorge Alio del Barrio MD PhD FEBOS-CR
Cornea, Cataract and Refractive Surgery Unit
Vissum Corporación, Alicante, Spain
Division of Ophthalmology
School of Medicine, Universidad Miguel Hernández
Alicante, Spain
Preface to the Third Edition
The journey of “Corneal Transplantation” book started in late 1990s with the joint efforts of corneal surgeons, including Professors Rasik B Vajpayee, Namrata Sharma, Geoffrey C Tabin, and Hugh R Taylor. The conceptualization of developing a practical handbook of corneal surgeries was aimed to cater to the needs of both a surgeon practicing in a rural area as well as a fellowship trained surgeon. First edition of this book was brought out in the year 2002, followed by a second edition in 2010.
The previous decade has witnessed significant popularization in terms of expanding indications of various techniques of corneal grafting such as the techniques of anterior as well as posterior lamellar keratoplasty, use of femtosecond laser for assisting various steps of corneal transplantation and limbal stem cell transplantation. This updated version “the third edition” is a conglomeration of 74 chapters, including the updated versions as well as the new ones.
New highlights of this edition include many innovative techniques of corneal transplantation such as Superficial Anterior Lamellar Keratoplasty, Diamond Knife-assisted Deep Anterior Lamellar Keratoplasty (Dia-DALK), Cannula Assisted DALK, Groove and Peel DALK, Thin Lenticule Descemet's Stripping Automated Endothelial Keratoplasty, Pre-Descemet's Endothelial Keratoplasty, Shaped Keratoplasty, Non-circular Corneal Grafts, Hemi-automated Lamellar Keratoplasty and Bowman's Layer Transplantation. A separate section on indication specific techniques of corneal transplantation has been included, consisting of a detailed description of several clinical conditions.
Providing cutting-edge information from experts all over the world, has been the primary focus of this book, since its inception. The aim is to help the corneal surgeons understand the intricacies of various techniques of corneal transplantation including the novel as well as the established ones. Relevant clinical photographs, sketch diagrams and surgical videos have been incorporated to further provide a lucid understanding of the facts.
Future treatment options for the management of corneal pathologies include use of tissue-engineered cornea, mesenchymal stem cell and cultured corneal endothelial cell therapy, use of ROCK inhibitors and gene therapy. These modalities are still in their initial phase of use, with limited number of patients being enrolled in certain parts of the world. End of this decade, will further determine their feasibility and effectiveness for the management of different types of corneal pathologies.
We are thankful to all our authors for sharing their expertise, their patience and cooperation and investing their precious time in writing the chapters in a reader-friendly and well-structured manner.
Namrata Sharma
Ritu Nagpal
Rasik B Vajpayee
Preface to the First Edition
Corneal Transplantation Surgery has undergone tremendous advancements over the last few decades. Innovative minds have been contributing novel and original concepts in an ongoing pursuit, aimed towards achieving optimal long-term success of this craft. My journey in the field of corneal grafting surgery began during my residency at Gandhi Medical College, Bhopal, Madhya Pradesh, India. In those formative years, it was thrilling to observe surgeons replace diseased and scarred corneas with healthy donor tissue. After a formal training in corneal surgery at Dr Rajendra Prasad Centre for Ophthalmic Sciences, I learnt the finer points of this craft at the Cornea Service of Melbourne University Department of Ophthalmology in Australia. I would like to express my heartfelt gratitude to my teachers Professor Santokh Singh, Professor MK Rathore, Dr Salil Kumar, Professor Madan Mohan, Professor VK Dada, Professor Hugh R Taylor and Professor Peter R Laibson. These luminaries have helped me to shape my skills as an ophthalmologist and a corneal surgeon and have been a source of inspiration in my academic endeavors including this book.
This book was conceived in Australia, when Dr Geoff Tabin and myself were working as corneal fellows with Professor Hugh R Taylor. Our interactions with him made us realize that the profile of corneal diseases and their management modalities in the developing world differ somewhat from those of the developed nations. We felt that there was a need for a concise, user-friendly and practical book on corneal grafting surgery. The book was planned as an amalgamation of knowledge about the newer technological advances of the developed world and the simpler alternatives appropriate and optimal for the developing countries. Another principal purpose of this venture is to generate interest amongst ophthalmic surgeons of the developing countries in the field of corneal grafting surgery, as corneal blindness is a major health issue here.
Bringing out a book on a subject such as corneal transplantation is a kind of mammoth exercise and it is clear that work of such enormity is the congregation of efforts of many individuals. I am grateful for the esprit de corps, collaboration, education and altruism that my Australian, American and other International and Indian colleagues have bestowed on me over the years. Many of them are contributing authors to this book. I am obliged to all the contributing authors for the time and effort they have put in to share their expertise and knowledge with the readers. I am indebted to my co-editors Dr Namrata Sharma, Dr Geoff Tabin and Professor Hugh R Taylor for their invaluable help and guidance at every step. I would also like to acknowledge my residents, and my assistants Mr Rajkumar and Ms Meena Verma for providing useful inputs and assistance. And finally, I would like to thank my wife Madhu and children Mihika and Shubhankar for their patience in allowing me to spend time to accomplish this work.
This book has been designed as a practical guide to the various aspects of corneal grafting surgery. It elucidates the basic aspects in preoperative evaluation, investigations, established surgical procedures and the advanced techniques in special situations as well as the newer technology in corneal grafting. Theoretical as well as research aspects of corneal grafting have been dealt in a practical manner. An extensive and well-illustrated section provides up-to-date knowledge of complications in corneal transplantation and their management. This should be of particular assistance to ophthalmologists practicing in remote areas and involved in the postoperative care of the grafted patients.
Overall our book provides students, surgeons and practitioners a concise treatise on corneal transplantation that contains essential information intended to help a beginner and can be consulted by the experienced corneal transplantation surgeons to acquaint themselves with the state-of-the-art techniques in corneal grafting surgery.
Rasik B Vajpayee
Preface to the First Edition
In the early 1990s Rasik B Vajpayee and I were corneal fellows together under the guidance of Professor Hugh R Taylor at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia. Dr Vajpayee had come from the busy corneal unit at the All India Institute of Medical Sciences in New Delhi and he was concerned about the difficulties of corneal surgery in the developing world. I trained at Harvard Medical School and Brown University's Department of Ophthalmology in the United States of America and arrived with a bias towards modern technology and no holds barred best possible care for every individual patient. Professor Taylor's superb corneal fellowship provided us with both a state-of-the-art corneal fellowship experience and the opportunity to discuss wider global issues surrounding the delivery of medical care both in the developed and developing world.
Dr Vajpayee returned to India where he quickly became one of the busiest and most influential corneal surgeons in the world. He has an enormous surgical volume and innovative mind. He has developed numerous new techniques and has advanced the art of corneal surgery in a myriad of areas. Along with his publications, he experienced a meteoric rise through the academic ranks. Dr Vajpayee is now a full Professor at the All India Institute of Medical Sciences and Director of Cornea Services. In addition to being involved with many aspects of cutting edge research and technology, he has continued to be concerned about the difficulties of delivering high quality corneal care in the developing world.
Dr Vajpayee and I spoke at the American Academy of Ophthalmology meeting one year ago. He felt that there was a need for a practical book on modern corneal surgery that would transcend the boundaries of modern technology and the developing world. He noted that there was no single book that would allow a rural surgeon in India to quickly learn what he needs to treat a specific difficult corneal pathology that also provides in depth discussions and insights for the western fellowship trained corneal surgeon. Professor Vajpayee's enthusiasm was infectious. We discussed ideas and possible formats and drew up a list of topics. We then discussed who in the world was currently at the absolute cutting edge in dealing with those specific problems. We enlisted the help of Professor Taylor from Australia and Dr Namrata Sharma from India as co-editors and approached an all star cast of corneal specialists from around the world.
We asked the authors to write succinct practical chapters geared towards patient care while still including sufficient academic support for their views. In each chapter, the authors delivered an excellent treatise on their topic of specific corneal expertise. We hope this book will be a valuable resource for general ophthalmologists who are faced with a corneal crisis, residents and corneal specialists alike. As we enter a new millennium, corneal disease and injury remains the second leading cause of blindness in the world. We hope this book will provide a practical, yet comprehensive, guide to surgical corneal care.
I am indebted to all of our chapter authors and to my co-editors for their hard work. I am particularly grateful to Rasik B Vajpayee for having the vision of this book and the enthusiasm to make it a reality. Happy reading!
Geoffrey C Tabin
Preface to the First Edition
I was very pleased when Rasik B Vajpayee first raised the possibility of writing a book on corneal transplantation. Dr Vajpayee, in addition to being an expert surgeon is also one of the most industrious and productive members of a new generation of corneal surgeons and is rapidly becoming a world leader.
He has assembled a most distinguished group of leading corneal surgeons from around the world to contribute to this very important and impressive book.
There have been many significant and exciting developments in the technical aspects of corneal transplantation over recent years and these have been beautifully set out in the chapters that follow. The precision and beauty of corneal transplantation still amazes me after thirty years. With the large numbers of cases done around the world each year and the high success rate, corneal transplantation must be without doubt the most successful example of transplantation in the whole of medicine. Although exquisite surgical skill and attention to detail throughout the operation are extremely important in determining the successful outcome of corneal transplantation, they are only part of the story.
Data from the Australian Corneal Transplant Registry show that the single most important factor affecting the long-term survival of corneal grafts is the surgeon. This does not relate to the surgical skill and dexterity as much as it relates to meticulous postoperative management. The key to the successful postoperative management of a corneal transplant is not how many patients are seen, or whether they are seen exactly at the time of their appointment without having to wait, or whether they are first examined by an ophthalmic assistant, the key is the meticulous attention to detail in the postoperative management especially the recognition of early stages of low-grade rejection and its appropriate management. Attention to detail is a key to success in ophthalmology, and in no area is this more true than the postoperative management of corneal transplantation.
One of the great strengths of this book is the wide range of experience and opinion that is presented here. This book does not give a simplistic cookbook recipe for the management of these sometimes complex and difficult cases, rather it gives the distilled experience of the world's leaders in this field in which they outline their approach and their justification for the decisions they have taken. I trust you will find this book as interesting and as informative as I have and sustain the excitement I first felt when this book was first discussed.
Hugh R Taylor
Synopsis
The first edition of “Corneal Transplantation” was published in the year 2002 by the combined effort of various experts in corneal transplantation across the globe. It was Professor Rasik B Vajpayee's idea to have a single book which would guide the corneal surgeons, as to how to address a specific corneal pathology. In quest of better postoperative outcomes and improved survival rates for corneal grafts, corneal surgeons continue to refine the techniques of corneal transplantation. We have moved from transplanting full thickness donor corneal tissues to transplantation of selective tissue layers such as Bowman layer transplantation, automated lamellar therapeutic keratoplasty (ALTK) and Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty. The understanding as well as the management of various corneal pathologies has undergone tremendous changes in the past few years. The third edition of this book amalgamates the most recent advances in corneal transplantation techniques with newer concepts of various corneal pathologies, the upgradation of previously described surgical techniques and introduction to the novel techniques in component surgery of cornea.