partnerships for success: corneal transplant in the 21st century
DESCRIPTION
Partnerships for Success: Corneal Transplant in the 21st Century. Presenters: Christopher Blanton, MD Medical Director, Ocular Services, OneLegacy Jessica Horton Respiratory Therapist & Cornea Recipient, Antelope Valley Hospital Moderator: - PowerPoint PPT PresentationTRANSCRIPT
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Partnerships for Success: Corneal Transplant in the 21st Century
Breakout Session A
Presenters:Christopher Blanton, MD
Medical Director, Ocular Services, OneLegacy Jessica Horton
Respiratory Therapist & Cornea Recipient, Antelope Valley Hospital
Moderator:Sherri Lamon, RN, PIH Health
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• Understand the importance of good eye care
• Recognize the benefits of timely referrals• Be aware of indications for corneal
transplant and innovative remedies.
Objectives
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•How do your actions in the hospital affect the gift of sight?
Question to Run on
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The BasicsThe goal of the cornea is to
focus light to a point on the retina.
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What two requirements are necessary for the cornea to
perform this function?
Transparency and correct shape
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Corneal Anatomy
•Epithelium- 50 microns•Bowman’s Layer- 12 microns•Stroma- 450-900 microns•Descemet’s membrane- 3-12 microns•Endothelium- 4-6 microns
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Corneal Anatomy
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Corneal Transplant Surgery
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Trephine of Donor Tissue
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Trephine of Donor Tissue
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Trephine of Donor Tissue
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Trephine of Donor Tissue
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Initial Incision into Eye
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Removal of Diseased Corneal Tissue
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"Open Sky" Portion of Surgery
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Sewing donor tissue into place
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Suturing Healthy Donor Tissue into Place
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Pseudophakic BullousKeratopathy
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Bullous Keratopathy-Fuchs' Dystrophy
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Endothelial Disease
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Failed Corneal Transplant
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Keratoconus
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Keratoconus – Advanced
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Corneal Scar
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Corneal Scar – High Mag
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Corneal Scar Infectious Viral
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Corneal Scar – Infectious Bacterial
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Corneal Perforation
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Corneal Dystrophies
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Corneal Dystrophy Treated with Excimer Laser
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Chemical Burn
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Partial Thickness•DLEK•DSEK•DSAEK
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Deep Lamellar•Replacing Descemet’s and
Endothelial layer•Difficult dissection technique for
both donor and host cornea
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Descemet’s Stripping•Manual Dissection-host and
donor•Automated -donor
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DSAEK Graft
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IntraLase Enabled Keratoplasty
The IntraLase Enabled Keratoplasty software can be programmed to produce different configurations with computer precision.
Historical use of trephination utilizing different shapes has taught us that different configurations have unique features that can be used for specific indications.
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IntraLase Enabled KeratoplastyThe IntraLase® FS ophthalmic surgical laser is cleared for the creation of a lamellar cut/resection of the cornea for lamellar keratoplasty and for the creation of a PENETRATING CUT/INCISION for penetrating keratoplasty
The IntraLase FS surgical laser can perform the following cuts that when combined at different angles can create various geometrically shaped corneal resections at the surgeon’s desired depth.
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IntraLase Enabled Keratoplasty The IntraLase Enabled Keratoplasty application allows the user to perform three cut segments: a posterior side cut, lamellar cut, and anterior side cut.
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The IntraLase Enabled Keratoplasty application allows the user to perform three cut segments: a posterior side cut, lamellar cut, and anterior side cut.
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Red 90 degreesBlue 30 degreesYellow 150 degreesDotted line angle measurement
Cut Angles
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Example Pattern Combinations
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Actual Surgery
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OCT of Standard PK
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OCT of Zig-Zag IEK
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•Making the Referral•Approach for Donation•Maintain the Opportunity•Ventilated or Comatose Patients
Key Elements in Caring for Potential Donors
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•Report all imminent/cardiac deaths within ONE HOUR
•Regardless of medical condition, age, advanced directive
•HIPAA compliant
Making the Referral
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•Allows time to serve the family•Preserves organ and tissue viability•Ensures compliance with federal and state laws
Why?
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• Most deaths will not be eligible for donation• Do not approach independently of
OneLegacy.• Have medical chart available for OneLegacy
to determine suitability.• LNOK contact information
Approaching for Donation
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• Ventilated or comatose patients- lubricate eyes frequently : every 4-6 hours gel is better than tears
• Deceased patients- wait for go ahead from One Legacy: eye care may interfere with M.E./coroner's investigation.
Maintain Opportunity for Corneal Donation
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Poor Eye Care Can Damage the Cornea
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Healthy Donor Tissue Cures Blindness
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Jessica HortonRespiratory Therapist & Cornea Recipient
Antelope Valley Hospital
Partnerships for Success: Corneal Transplant in the 21st Century
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•How do your actions in the hospital affect the gift of sight?
Question to Run on
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For more information…
(213) 207-4200