1. 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

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

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

4. The Basics The goal of the cornea is to focus light to a point on the retina.

5. What two requirements are necessary for the cornea to perform this function? Transparency and correct shape

6. Corneal Anatomy Epithelium- 50 microns Bowman’s Layer- 12 microns Stroma- 450-900 microns Descemet’s membrane- 3-12 microns Endothelium- 4-6 microns

7. Corneal Anatomy

8. Corneal Transplant Surgery

9. Trephine of Donor Tissue

13. Initial Incision into Eye

14. Removal of Diseased Corneal Tissue

15. "Open Sky" Portion of Surgery

16. Sewing donor tissue into place

17. Suturing Healthy Donor Tissue into Place

18. Pseudophakic Bullous Keratopathy

19. Bullous Keratopathy-Fuchs' Dystrophy

20. Endothelial Disease

21. Failed Corneal Transplant

22. Keratoconus

23. Keratoconus – Advanced

24. Corneal Scar

25. Corneal Scar – High Mag

26. Corneal Scar Infectious Viral

27. Corneal Scar – Infectious Bacterial

28. Corneal Perforation

29. Corneal Dystrophies

30. Corneal Dystrophy Treated with Excimer Laser

31. Chemical Burn

32. Partial Thickness DLEK DSEK DSAEK

33. Deep Lamellar Replacing Descemet’s and Endothelial layer Difficult dissection technique for both donor and host cornea

34. Descemet’s Stripping Manual Dissection-host and donor Automated -donor

35. DSAEK Graft

36. 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.

37. 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.

38. 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.

40. Red90 degrees Blue30 degrees Yellow150 degrees Dotted lineangle measurement Cut Angles

41. Example Pattern Combinations

42. Actual Surgery

43. OCT of Standard PK

44. OCT of Zig-Zag IEK

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

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

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

49. 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

50. 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

51. Poor Eye Care Can Damage the Cornea

52. Healthy Donor Tissue Cures Blindness

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

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

55. For more information… (213) 207-4200