20
Lamellar Keratoplasty

See Chapter 3.

Ensure that the cornea is not perforated. Treat any infectious process as necessary. Either viable (fresh) or nonviable (frozen or glycerin-preserved) donor tissue may be used.

Instrumentation

Donor eye (fresh, frozen, or glycerin-preserved) It is often helpful to have a second eye available if there is difficulty in preparing the first donor button. Moreover, tissue adhesive should be available and viable full-thickness donor tissue on standby if intraoperative perforation of the cornea is a possibility.

Lid speculum (e.g., Lieberman)

Sutures (4–0 silk, 10–0 nylon)

Fine tissue forceps (e.g., 0.12 mm Castroviejo or Colibri, Pierse forceps)

Scalpel (e.g., #15 Bard-Parker blade)

Martinez dissector

Scarifier (e.g., Grieshaber #681.01 or Beaver #57)

Disposable trephine (e.g., Storz, Weck)

Vacuum trephine (e.g., Hessburg-Barron)

Vannas scissors

Kalt needle holder

Fine nonlocking needle holder

Elschnig forceps

Cellulose sponges

Paufique knife

Suarez spreader

Operative Procedure

1. Anesthesia: Peribulbar or retrobulbar injection plus lid block. May use general anesthesia if preferred for younger or uncooperative patients, hearing or mentally impaired patients, or those with language obstacles.

2. Prep and drape.

a. Use povidone-iodide 5% on a cotton-tipped applicator to gently clean eyelashes and lid margins.

b. Place one or two drops of povidone-iodide in the conjunctival fornix.

3. Donor preparation.

a. Use fresh or frozen whole donor eye.

b. For ease of manipulation, wrap eye in gauze, leaving cornea visible.

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