Tectonic Penetrating Keratoplasty for Corneal Perforation
Contributors: James M. Huffman, MD and Mark A. Greiner, MD
Additional Note: Length 02:22
Posted May 31, 2019
The patient presented with a large peripheral corneal ulcer. He was followed initially at an outside location. Cultures were obtained and positive for Aspergillis fumigatus. Topical amphotericin 0.15% and natamycin 5% were started. Unfortunately, the patient presented several days later with a corneal perforation. He then underwent placement of a corneal patch graft.
- The corneal perforation is measured with calipers.
- Next a 4mm dermatology punch is used to place an orientation mark surrounding the perforation.
- Anatomical marks are then placed on the donor tissue.
- The tissue is then trephined with a 5mm dermatology punch. Optisol-GS is then placed in the Teflon block with the donor tissue.
- A paracentesis is made in the peripheral cornea with a 1.0mm sideport blade.
- The anterior chamber is then formed with Healon.
- The 4mm trephine is then used to partially trephine through the epithelium and into the anterior stroma along the previously placed mark.
- An adjustable diamond radial keratotomy knife is then set to 400 microns. The blade is used to deepen the partial-thickness trephination.
- A 15-degree blade is used to enter the anterior chamber and the corneal button is removed with curved Cindy scissors.
- The donor tissue is then placed onto the ocular surface with a Paton spatula.
- 10-0 nylon on an AU5 needle is then used to place eight interrupted sutures. Slip knots are used to allow for suture tension adjustment. Once the suture tension is appropriate, the third and fourth throws are completed and the knots are buried.
- Healon is then removed from the anterior chamber and the anterior and posterior suture line is checked for leaks.
- A collagen shield is placed onto the ocular surface.
last updated: 05/31/2019
