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
Objectives

• Understand the importance of good eye

care
• Recognize the benefits of timely referrals
• Be aware of indications for corneal
transplant and innovative remedies.
Question to Run on

• How do your actions in the hospital

affect the gift of sight?
 The Basics
The goal of the cornea is to
focus light to a point on the retina.
 What two requirements
are necessary for the cornea to
perform this function?

Transparency and correct shape

 Corneal Anatomy

• Epithelium- 50 microns
• Bowman’s Layer- 12 microns
• Stroma- 450-900 microns
• Descemet’s membrane- 3-12 microns
• Endothelium- 4-6 microns
Corneal Anatomy
Corneal Transplant Surgery
Trephine of Donor Tissue
Trephine of Donor Tissue
Trephine of Donor Tissue
Trephine of Donor Tissue
Initial Incision into Eye
 Removal of
Diseased Corneal Tissue
"Open Sky" Portion of Surgery
Sewing donor tissue into place
Suturing Healthy Donor Tissue
into Place
Pseudophakic Bullous
Keratopathy
Bullous Keratopathy-Fuchs'
Dystrophy
Endothelial Disease
Failed Corneal Transplant
Keratoconus
Keratoconus – Advanced
Corneal Scar
Corneal Scar – High Mag
Corneal Scar Infectious Viral
Corneal Scar – Infectious Bacterial
Corneal Perforation
Corneal Dystrophies
 Corneal Dystrophy
Treated with Excimer Laser
Chemical Burn
 Partial Thickness
•DLEK
•DSEK
•DSAEK
 Deep Lamellar
• Replacing Descemet’s and
Endothelial layer
• Difficult dissection technique for
both donor and host cornea
 Descemet’s Stripping
• Manual Dissection-host and
donor
• Automated -donor
DSAEK Graft
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.
IntraLase Enabled Keratoplasty
The 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.
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.
The IntraLase Enabled Keratoplasty application allows the user to
perform three cut segments: a posterior side cut, lamellar cut, and
anterior side cut.
 Cut Angles

Red 90 degrees
Blue 30 degrees
Yellow 150 degrees
Dotted line angle measurement
Example Pattern Combinations
Actual Surgery
OCT of Standard PK
OCT of Zig-Zag IEK
Key Elements in
Caring for Potential Donors
• Making the Referral
• Approach for Donation
• Maintain the Opportunity
• Ventilated or Comatose Patients
Making the Referral

• Report all imminent/cardiac deaths

within ONE HOUR
• Regardless of medical condition, age,
advanced directive
• HIPAA compliant
Why?

• Allows time to serve the family

• Preserves organ and tissue viability
• Ensures compliance with federal and
state laws
Approaching for Donation

• 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
Maintain Opportunity for
Corneal Donation

• 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.
 Poor Eye Care
Can Damage the Cornea
Healthy Donor Tissue
Cures Blindness
 Partnerships for Success:
Corneal Transplant in the 21st Century

Jessica Horton
Respiratory Therapist & Cornea Recipient
Antelope Valley Hospital
Question to Run on

• How do your actions in the hospital

affect the gift of sight?
For more information…

(213) 207-4200