KERATOPLASTY
PATIENTS DISEASED CORNEA IS REPLACED BY
HEALTHY CORNEA
CORNEAL GRAFTING OR CORNEAL
TRANSPLANTATION
KERATOPLASTY
AUTO-KERATOPLASTY ALLO-KERATOPLASTY
• Rotational • Penetrating
• Contralateral • Lamellar
• Small patch graft
AUTO-KERATOPLASTY
• Contralateral
• Rotational • Indicated when cornea of one
eye of the patient is opaue and
• Patients own cornea is trephined
the other eye is blind due to
and rotated to transfer the posterior segment disease with
pupillary area having a small clear cornea.
corneal opacity to the periphery
• The cornea of two eye are
exchanged with each other.
ALLO KERATOPLASTY
• Penetrating keratoplasty
• Small patch graft
• Full thickness grafting
• lamellar keratoplasty
Partial thickness grafting
• Anterior lamellar
keratoplasty
• Posterior lamellar
keratoplasty
LAMELLAR KERATOPLASTY
ANTERIOR LAMELLAR POSTERIOR LAMELLAR
• Performed when the • Descemet’s stripping endothelial
keratoplasty
endothelium and Descemet’s
• Descemet’s stripping Automated
membrane are normal
endothelial keratoplasty
• Superficial Anterior lamellar • Descemet’s membrane endothelial
keratoplasty
• Deep Anterior lamellar
• Pre Descemet’s stripping automated
endothelial keratoplasty
TYPES OF
KERATOPLASTY
SURGICAL TECHNIQUE OF PENETRATING KERATOPLASTY
• Excision of donor corneal button: donor corneal button should be
cut 0.25mm larger than recipient
• Excision of recipient corneal button: with corneal trephine (7.5 -8
mm) a partial thickness incision is made, then anterior chamber is
entered with help of razor blade knife and excision is complete using
corneoscleral scissors
• Suturing of corneal graft into the host bed: using10 - 0 nylon
sutures, continuous or interrupted
INDICATIONS OF PENETRATING
KERATOPLASTY
• Optical : (improve vision) corneal opacity, bullous keratopathy, corneal
dystrophies, advanced keratoconus
• Therapeutic : (inflamed cornea not responding to conventional
therapy) non healing corneal ulcer
• Tectonic graft : (restore integrity of eye ball)after corneal perforation
and marked corneal thinning
• Cosmetic : (improve the appearance of the eye)
INDICATION OF ENDOTHELIAL KERATOPLASTY
• Fuchs endothelial dystrophy
• Pseudophakic corneal edema
• Posterior polymorphus dystrophy
• Aphakic corneal oedema
• Iridocorneal endothelium syndrome
• Failed corneal graft
COMPLICATIONS
EARLY COMPLICATIONS LATE COMPLICATIONS
• Flat anterior chamber • Graft rejection
• Iris prolapse • Recurrence
• Infection • Astigmatism
• Secondary glaucoma
• Epithelial defects
• Primary Graft failure
GRAFT REJECTION
• It can occur as early as 2 weeks to • Clinical presentations
several years after grafting • Epithelial rejection : elevated
• A delayed type of hypersensitivity epithelial rejection line
response • Subepithelial infiltrates – Kayes dots
• Risk factors: • Stromal rejection : stromal haze
• Young age • Endothelial rejection
• Previous graft failure • Khodadoust line demarcating
• Corneal vascularization healthy and damaged endothelium
• Large graft size • Diffuse endothelial rejection lots of
• Massive blood transfusion Keratic precipitates
