cornea surgery

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  • 1. 28/04/2010 CORNEAL SURGERYDr Frank FAMOSEDVM, CES Ophtalmologie Ekaterinburg May 2010Surgical anatomy of corneaPrecorneal tear filmEpitheliumStromaDescemets membraneEndothelium 1

2. 28/04/2010Corneal healingAvascular healing EdemaVascular healingVascularisation Scar formation Pigmentation DegenerationCorneal preparation Hair clippingDesinfectionDrapingOcular fixation2 3. 28/04/2010Corneal surgery : microscopeCorneal surgery : materialCutting knivesDisposableBlade-holdersDissection knivesTrephinesScissors 3 4. 28/04/2010Corneal surgery : materialGrasps & forcepsNeedle-holderSuture materialKERATECTOMIES 4 5. 28/04/2010Indications : superficial cornealdiseases Corneal dermods Corneal lipidosis Recurrent cornealerosions Feline cornealsequestraCorneal surgery : keratectomiesTechnical aspectsIndications SuperficialkeratectomyPractical realisation SuperficialkeratotomyResults Corneal biopsyFollow-upComplications 5 6. 28/04/2010Superficial keratectomy :indicationsCorneal dermodsCorneal lipidosisFeline corneal sequestraInflammatory keratopathiesSuperficial keratectomy : practicalrealisation Corneal incision Stroma dissection &separation Removal of cornealparts6 7. 28/04/2010Superficial keratectomy : results Transparency Vascular invasion Pain PigmentationSuperficial keratectomy : Follow-upPost-operative treatment Local antibiotics Local corticosterods ?Follow-up7 8. 28/04/2010Superficial keratectomy :complications Infection Fibrosis Delayed healing PigmentationPunctuate and grid keratotomy :indicationsNon healing superfical corneal ulcers in dogsR/O other causesNot in cats8 9. 28/04/2010Punctuate and grid keratotomy :practical realisationEpithelial debridementAnterior stromal keratotomyCorneal protectionPunctuate and grid keratotomy :resultsEpithelial healingVascular invasionPainPigmentation9 10. 28/04/2010Punctuate and grid keratotomy :Follow-upUlcer healingMedical treatmentPunctuate and grid keratotomy :complicationsNon-healing ulcersCorneal granulomaDeep stromal inflammationCorneal scars 10 11. 28/04/2010CONJUNCTIVALGRAFTSIndicationsDeep corneal defectsOcular perforationKeratomalacia11 12. 28/04/2010Types of conjunctival graftsPediculeIsland graftBridgeCompletePractical realization Corneal preparation DebridementSepsis treatment Graft preparation Subconj. injection Suture 12 13. 28/04/2010Practical realization : pedicleIndications Central ParacentralDifficultiesGrafts dimensionsTensionPractical realization : islandIndications Central ParacentralDifficulties Manipulation of graft 13 14. 28/04/2010Practical realization : completeIndication Large central Multiple lesions keratomalaciaDifficulties No cornealvisualisationFollow-upSutures D2 to D10Tissue Retraction D7Leakage (if perforated) D2xxxxxxxxxxxxxxxxxRemoval of pedicle D21 14 15. 28/04/2010Complications : causesSutures or knotsExcessive tension failureor stretchingIncomplete covering Wound infectionLeakage Incompletepreparation ofOblic graft directioncornea 15 16. 28/04/20103216 17. 28/04/2010333417 18. 28/04/2010ConclusionSurgical rules and materialSimple techniques for keratectomyMany technical possibilities with conjunctival grafts 18

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