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2 Cornea Draft 2 March 2006

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1. History This SOP follows ISO 9001 (2001) guidelines. 2. Goal This SOP describes the surgical technique for Deep Anterior Lamellar Keratoplasty (DALK). 3. Responsibilities Ophthalmologist 4. Description
Preparation-Local 1. Check patient data in 2. Check patient name and number on donor vial 3. Sign Informed Consent 4. Administration pre-operative drops and anesthesia: see P-SOP 4 5. Honan Balloon for 10 minutes 40mmHg 6. Set up NIPD monitor 7. Patient in anti-Trendelenburg position Sterile set up 8. Set up microscope. 9. Disinfect the periocular skin and fornix with Betadine 0.5% for 5 minutes 10. Cover with sterile drape Surgery procedure 11. Cover eye with aperture drape 12. Insert eye speculum 13. Rinse fornix 20 ml NaCl 0.9% to wash out Betadine 14. Open conjunctiva at 12 oclock and make a 5.0 mm half-depth scleral incision with crescent knife 15. Elongate incision with crescent knife until 2 mm in clear cornea 16. Cut side port at 3 and 9 0clock position with 30knife and place air in AC. 17. Dissect with DALK instrument set 18. Remove air out of AC and insert viscoelastic in interface 19. Trephine recipient button 20. Take donor out of vial and punch 21. Rinse recipient bed 22. Position donor and mark 23. Suture donor in place with double 10-0 nylon 24. Put tension in eye and check incision 25. Lidocane / gentamycine / Celestone subconjunctival injection 26. Dexamethasone ointment 27. Transparent eyes-hield
Cornea on OC medium check nrs! Disposable cap and shoe covers patient Non-sterile gauze swab Betadine 0.5% / Swabs / Vial Tetracane 0.5% ocgtt NaCl 0.9% Lidocane 1% preservative free Mask + cap Sterile cover large 2x Sterile gloves Surgeon disposable gown Instrumentset DALK 2x cover scissors 1x eye speculum 1x DALK spatula set 1x fine surgical forceps (straight) 1x larger surgical forceps 1x needle holder 2x suture pincet 1x calliper 1x marker 1x punch trephine 8.5 + 9.0 mm 1x punch block 1x glass bowl On sterile table surface 1x HB trephine 8.0 mm 2x AC rinse fluid 1x VisionBlue 1x Ocucoat 1x marker pen 1x 10-0 nylon suture. CU-1 needle Disposable DALK set Gauze Aperture drape Incision foil Barrier-flex 1x 22.5o knife 1x crescent knife 1x sponges 1x syringe 1 ml (air) 2x syringe 2 ml (lido/GC) 1x syringe 5 ml (BSS) 1x syringe 20 ml (NaCl) 1x VOK cannula 1x 30G cannula (BSS + sc injection) 3x 22G cannula (NaCL/lido/GC) 1x 27G cannula Celestone Gentamicin 40mg/ml Dexamethasone ointment Eyeshield/ tape
MHR P-SOP 5.2 Cornea Deep anterior lamellar keratoplasty (DALK) - ENG

5. Forms and Appendices - None 6. Reports and Archives Patient data will be stored in patient file in 7. References None

MHR P-SOP 5.2 Cornea Deep anterior lamellar keratoplasty (DALK) - ENG

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