Corneal

transplantation
• Corneal transplantation is also called corneal grafting or keratoplasty
is an operation in which the diseased cornea is removed and replaced
with a healthy donor cornea
Types
Corneal allografts can be of various types
• Penetrating keratoplasty [ full thickness grafting ]
• Lamellar keratoplasty [ partial thickness grafting ]
• Small patch grafting
Indications

• Optical :to improve vision

Important indications are :
• Corneal opacity
• Bullous keratopathy
• Corneal dystrophies
• Advanced keratokonus
Therapeutic
To replace inflamed cornea not responding to conventional therapy
Tectonic graft : to restore integrity of eyeball .
Eg: other corneal perforation, marked corneal thinning
Cosmetic: to improve the appearance of the eye
DONOR TISSUE
• Donor corneas are harvested harvesting from cadaveric donors within
6 hours after death,sometimes upto 12 hours after death in contries
with cold climate
• They can do transplanted immediately or preserved in eye bank by
various preservation technique for varying intervels
Methods of corneal preservation

• Short term storage [ upto 48 hrs]

The whole globe is preserved at 4 degree Celsius in a moist chamber
• Intermediate storage [ upto 2 weeks]
It can be in Mc carey –kaufman [ MK ] medium and various chondroitin
sulphate enriched media such as optisol medium
• Long term storage upto 35 days
Is done by original culture method
Surgical technique
• Excision of donor corneal button
the donor corneal button shoud be cut 0.25 mm larger than the
recipient,taking care not to damage the endothelium
• Excision of recipient corneal button
with the help of a corneal trephine [ 7.5 mm-8 mm in size ] a partial
thickness incision is made in the host cornea. Then anterior chamber is entered with
the help of a razor blade ,knife and excision is completed using cornea scleral
scissors
• Suturing of corneal graft into the host bed
it is done with either continuous or interrupted 10-0 nylon sutures
• A sub conjunctival infection of antibiotic and steroid is administered and an eye
pad with a shield or bandage applied
 Preoperative nursing management
• Identify the patient and donor
• Consent should be taken from patient and donor
• PAC should be done
• Preoperative evaluation should be done,that includes
Evaluation of potential
Occular surface abnormalities and inflammation
Increased IOP
Status of lens vitreous retina,optic nerve
• Prepare the patient for surgery
• Preoperative medications should be administered
• Provide psychological support to the patient and family members
Postoperative nursing management
• Monitor vital signs
• Administer medication as per order
• Educate the patient about the signs of rejection ,following keratoplasty and
ask to report immediately if this occur
• Educate the patient that the visual recovery should be immediately or take a
few months due to initial graft ,edema and astigmatism
• Advice to follow up weekly for 1st 3 months and then monthly till 6 months,
every 2 month for 1 year and yearly thereafter.
• Monitor for any complication
• Provide psychological support to the patient and family members
 Complications
1.Early complication
These include flat anterior chamber ,wound leak,persistant or non
healing epithelial defect ,iris prolapse,infection,secondary glaucoma,epithelial
defects and primary graft failure
2.Late complication [ after 3 weeks ]
 Graft rejection
Recurrence of disease and astigmatism
Graft infection
Loose sutures
TREATMENT : If administered immediately,maximise the chances of graft survival
EYE BANKING
Eye bank is an organization which deals with the collection
,storage and distribution of cornea for the purpose of corneal
grafting,research and supply of the eye tissue for other ophthalmic purpose
FUNCTIONS
• Promotion of eye donation by increasing awareness about eye donation to
the general public
• Registration of the pledger for eye donation
• Collection of the donated eye from the diseased
• Receiving and processing the donor eyes
• Preservation of the tissues for short ,immediate ,long or very long term
contd..
Contd….
• Distribution of the donor tissues to the corneal surgeon
• Research activities for the improvement of the preservation
,methodology,corneal substitutes and utilization of the other
components of the eye
EYE BANK PERSONNEL
• Eye bank incharge: qualified ophthalmologist
• Eye bank technician
Functions/duties :
Keep the eye collection kit ready to assist in enucleation of donor eyes
Record data pertaining to donor material and weighting list of patients
Process and treat the donor eyes with antibiotics
Assist in corneal preservation and storage
Maintain asepsis in the eye bank
• Clerk cum store keeper : the duties are
Maintain meticulous records
Coordinate with other eye banks
Deal with other eye banks regarding donors correspondence
Distribute cornea to eye surgeons
• Medical social worker/PRO :
To supply publicity material to common public
To promote voluntary eye donation
He may be a voluntary or paid worker
• Driver cum projectionist is required
 To maintain vehicle of eye bank
 To screen films of eye donation promotion in the community
EYE COLLECTION CENTERS

• These are the peripheral satellite of an eye bank for better

functioning.one collection centre is viably located at an urban area
with a population of more than 200,000. about 4-5 collection centres
are attached with each eye bank
FUNCTIONS OF EYE COLLECTION CENTRES
• Local publicity for eye donation
• Registration of voluntary donors’
• Collection of eyes
• Processing and transportation of collected eye
PERSONNEL

• Ophthalmic technician
• Voluntary agencies
LEGAL ASPECT
The collection and usage of donated eyes comes under the preview of
the transportation of human organs act 1994.