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

Understand the importance of good eye care Recognize the benefits of timely referrals Be aware of indications for corneal transplant and innovative remedies. Objectives

How do your actions in the hospital affect the gift of sight? Question to Run on

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 microns Descemet’s membrane microns Endothelium- 4-6 microns

Corneal Anatomy

Corneal Transplant Surgery

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.

Red90 degrees Blue30 degrees Yellow150 degrees Dotted lineangle measurement Cut Angles

Example Pattern Combinations

Actual Surgery

OCT of Standard PK

OCT of Zig-Zag IEK

Making the Referral Approach for Donation Maintain the Opportunity Ventilated or Comatose Patients Key Elements in Caring for Potential Donors

Report all imminent/cardiac deaths within ONE HOUR Regardless of medical condition, age, advanced directive HIPAA compliant Making the Referral

Allows time to serve the family Preserves organ and tissue viability Ensures compliance with federal and state laws Why?

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 Approaching for 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. Maintain Opportunity for Corneal Donation

Poor Eye Care Can Damage the Cornea

Healthy Donor Tissue Cures Blindness

Jessica Horton Respiratory Therapist & Cornea Recipient Antelope Valley Hospital Partnerships for Success: Corneal Transplant in the 21st Century

How do your actions in the hospital affect the gift of sight? Question to Run on

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