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Dr. Hoyos’s Step by Step Lamellar Corneal Graft
Jairo E Hoyos, Eduardo Arenas
CHAPTER 1:
History and Evolution of Lamellar Techniques in Corneal Surgery
INTRODUCTION
CHAPTER 2:
Why Should We Include Lamellar Techniques in Modern Corneal Surgery?
INTRODUCTION
Histophysiology of the Cornea
Refractive Role of the Cornea
INDICATIONS FOR A KERATOPLASTY
PENETRATING KERATOPLASTY: DRAWBACKS
LAMELLAR KERATOPLASTY: BENEFITS
Anterior Lamellar Keratoplasty
Posterior Lamellar Keratoplasty
LAMELLAR KERATOPLASTY: INDICATIONS
CONCLUSIONS
CHAPTER 3:
Several Techniques on Lamellar Keratoplasty
LAMELLAR GRAFTS CLASSIFICATION
Central
Peripheral
Corneoscleral
LAMELLAR GRAFTS COMBINED WITH CENTRAL PENETRATING TREPHINATION
LAMELLAR GRAFTS AT VARYING DEPTHS
Superficial
Anterior Lamellar Grafts
Automated Technique with Microkeratome
Laser Photoablative Lamellar Techniques
Stromal Lamellar Grafts
Deep Lamellar Grafts (Full Thickness Graft on a Lamellar Bed)
INTRALAMELLAR GRAFTS
POSTERIOR LAYER LAMELLAR GRAFT
COMPLICATIONS
Foreign Bodies in the Interface
Interface Fibrosis
Rupture of Descemet's Membrane
Translucid Transparency
Residual Refractive Defects
Graft Rejection
Interface Epithelialization
Epithelial Inclusion Cysts
Intrastromal Hematomas
Paralytic Mydriasis (Urrets Zavalía Syndrome)
Neovascularization at the Interphase
ARTIFICIAL CHAMBER
CHAPTER 4:
Anterior Lamellar Keratoplasty and Peeling-off Technique in Secondary Corneal Ectasias
INTRODUCTION
THE LAMELLAR TECHNIQUES
ANTERIOR LAMELLAR KERATOPLASTY AND PEELING-OFF TECHNIQUE
Indications
Purpose
Secondary Ectasias
Surgical Technique
Modified New Peeling-off Technique
Two Steps Diameters Modality
DISCUSSION
CHAPTER 5:
Epikeratoplasty (Onlay Lamellar Keratoplasty)
INTRODUCTION
SURGICAL OBJECTIVE
PREFERRED ANESTHESIA
DESCRIPTION OF SURGICAL PROCEDURE
PREFERRED INSTRUMENT LIST AND SURGICAL OPERATING ROOM SET-UP
POSTOPERATIVE MEDICATIONS
POSTOPERATIVE FOLLOW-UP SCHEDULE
AVOIDING POTENTIAL COMPLICATIONS: USEFUL SURGICAL TIPS
MANAGEMENT OF COMPLICATIONS
RESULTS
CONCLUSIONS
CHAPTER 6:
Air Lamellar Keratoplasty
SURGICAL OBJECTIVE
PREFERRED ANESTHESIA
PREOPERATIVE MEDICATIONS
DESCRIPTION OF SURGICAL PROCEDURE
POSTOPERATIVE MEDICATIONS
FOLLOW-UP SCHEDULE
RESULTS
CONCLUSIONS
CHAPTER 7:
The Big Bubble Technique for Deep Anterior Lamellar Keratoplasty
HISTORY
INTRODUCTION
TERMINOLOGY
INDICATIONS
CONTRAINDICATIONS
ADVANTAGES
LIMITATIONS
ANESTHETIC REQUIREMENTS
PREOPERATIVE TOPICAL MEDICATIONS
SURGICAL TECHNIQUE
Recipient Dissection
Donor Dissection
LIST OF SURGICAL INSTRUMENTS
POSTOPERATIVE MEDICATIONS
FOLLOW-UP SCHEDULE
PREVENTION OF COMPLICATIONS
MANAGEMENT OF COMPLICATIONS
RESULTS
CONCLUSIONS
CHAPTER 8:
Excimer Laser Lamellar Keratoplasty of Augmented Thickness (ELLKAT)
INTRODUCTION
CLINICAL INDICATIONS
OPTIC LAMELLAR KERATOPLASTY
Optic Lamellar Keratoplasty Used in Corneal Alterations such as Central Superficial Leukomas
Optic Lamellar Keratoplasty Used in Degenerative Pathologies such as Keratoconus
LAMELLAR KERATOPLASTY FOR KERATOCONUS
Manual Lamellar Keratoplasty
Lamellar Keratoplasty Using a Microkeratome
Lamellar Keratoplasty with Excimer Laser
Lamellar Keratoplasty with Femtosecond Laser or IntraLase
SURGICAL TECHNIQUE OF LAMELLAR KERATOPLASTY
Preparation of the Homoplastic Flap
Mechanized Technique with the Microkeratome
Technique with IntraLase or Femtosecond Laser
Refractive Treatment of the Flap with Excimer Laser
Preparation of the Implant Site
Mechanized Technique with the Microkeratome
Excimer Laser Techniques
Technique with the IntraLase
Application of the Lamella
PRE-AND POSTOPERATIVE TREATMENT
POSTOPERATIVE COURSE
COMPLICATIONS
DISCUSSION
ELLKAT FOR KERATOCONUS
Materials and Methods
Surgical Technique
Preparation of the Flap
Technique on the Patient
Results
INTRALASE TECHNIQUE FOR KERATOCONUS
Preparation of the Flap
Preparation of the Receiving Cornea
Results
OUR EXPERIENCE IN OTHER CLINICAL SITUATIONS
Materials and Methods
Surgical Technique
Preparation of the Flap
Technique on the Patient
Results
CHAPTER 9:
Deep Anterior Lamellar Keratoplasty in Keratoconus (DALK)
INTRODUCTION
KERATOCONUS
SURGICAL INDICATIONS
CONTRAINDICATIONS
DALK VS PENETRATING KERATOPLASTY IN KERATOCONUS
Advantages
Disadvantages
DALK SURGICAL TECHNIQUE
Patient Setting and Anesthesia Procedure
Host Cornea Preparation
Post-surgical Management
COMPLICATIONS
Intraoperative
Postoperative
CHAPTER 10:
Microkeratome-assisted Anterior Lamellar Keratoplasty: Surgical Technique
INTRODUCTION
ANTERIOR LAMELLAR KERATOPLASTY WITH ALTK SYSTEM: THE PROCEDURE
PERSONAL TECHNIQUE: SURGICAL STEPS
CHAPTER 11:
Deep Lamellar Endothelial Keratoplasty (DLEK): Small and Large Incision Techniques
INTRODUCTION
ANESTHESIA
PREOPERATIVE MEDICATIONS
DEEP LAMELLAR ENDOTHELIAL KERATOPLASTY (DLEK): SMALL INCISION TECHNIQUE
Donor Tissue Preparation
Transplantation of the Donor Tissue
DEEP LAMELLAR ENDOTHELIAL KERATOPLASTY (DLEK): LARGE INCISION TECHNIQUE
COMBINED SURGERY WITH DLEK
POSTOPERATIVE COURSE
CHAPTER 12:
Lamellar Sclerokeratoplasty
INTRODUCTION
SURGICAL OBJECTIVE
PREFERRED ANESTHESIA
DESCRIPTION OF SURGICAL PROCEDURE
POSTOPERATIVE MEDICATIONS
FOLLOW-UP SCHEDULE
MANAGEMENT OF COMPLICATIONS
DISCUSSION
CHAPTER 13:
Management of Peripheral Corneal Lesions with Lamellar Keratoplasty
INTRODUCTION
SURGICAL INDICATIONS
Degenerative Corneal Disorders
Pellucid Marginal Degeneration
Terrien's Marginal Degeneration
Immunological Disorders
Corneal Infections
Corneal Tumors
SURGICAL PROCEDURE
Anesthesia
Surgical Technique
Dissection of Host Tissue
Preparation of Donor Tissue
Suturing of Donor Graft to Host Bed
Modified Surgical Techniques
Postoperative Care
COMPLICATIONS
OUTCOMES
CONCLUSIONS
INDEX
TOC
Index
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