Our Summary

This research paper discusses recent advancements in corneal transplantation, a type of eye surgery. For over a century, the primary method was penetrating keratoplasty, but in the past two decades, selective lamellar keratoplasty has become the preferred technique. Other advanced methods like corneal limbal stem cell transplant and keratoprosthesis are also now available.

The paper identifies the main complications of this surgery as being the pushing out of eye contents and severe bleeding in the choroidal, part of the eye. It emphasizes the need for eye specialists providing anesthesia to grasp these new surgical procedures to create the best conditions for surgery.

The goal of this article is to educate anesthetists about these recent surgical advancements in corneal transplantation and discuss the best anesthesia practices for these new techniques. General anesthesia is still suitable for many of these procedures, especially in repeat, difficult, or long surgeries.

The paper also discusses regional eye blocks as ideal for endothelial keratoplasty and as an alternative for penetrating keratoplasty after weighing the risks and benefits. It can also supplement general anesthesia. Meanwhile, topical anesthesia is another option when general anesthesia and regional eye blocks are not preferred. However, its use is generally limited.

FAQs

  1. What are the recent advancements in corneal transplantation surgery?
  2. What are the major surgical complications of corneal transplantation?
  3. What are the anaesthetic considerations for the new corneal transplantation techniques?

Doctor’s Tip

A helpful tip a doctor might tell a patient about corneal transplant is to follow all pre-operative instructions provided by the surgical team, such as avoiding certain medications or foods before the surgery. Additionally, it is important to attend all follow-up appointments after the surgery to monitor healing and prevent complications.

Suitable For

Patients who are typically recommended for corneal transplant are those with corneal diseases or conditions that cannot be effectively treated with other methods, such as:

  • Keratoconus
  • Fuchs’ dystrophy
  • Corneal scarring
  • Corneal ulceration
  • Corneal degeneration
  • Corneal dystrophies
  • Corneal trauma
  • Corneal infections

These patients may experience symptoms such as blurred vision, glare, halos, and eye pain, which can significantly impact their quality of life. Corneal transplant surgery can help improve vision and alleviate symptoms in these patients.

Timeline

Before Corneal Transplant:

  1. Patient undergoes initial consultation with an ophthalmologist to determine the need for a corneal transplant.
  2. Pre-operative testing is conducted, including a comprehensive eye exam and imaging studies to assess the condition of the cornea.
  3. Patient is informed about the risks and benefits of the surgery, as well as the potential outcomes.
  4. A suitable donor cornea is identified and prepared for transplantation.

After Corneal Transplant:

  1. Patient undergoes the corneal transplant surgery, which typically takes 1-2 hours to complete.
  2. Post-operative care includes regular follow-up appointments with the ophthalmologist to monitor the healing process and ensure proper integration of the donor cornea.
  3. Patient may experience temporary discomfort, blurred vision, and sensitivity to light in the days following surgery.
  4. As the eye heals, vision gradually improves and patient may be prescribed eye drops to prevent infection and promote healing.
  5. In some cases, additional procedures may be required to address complications or ensure optimal visual outcomes.
  6. Patient continues to follow up with the ophthalmologist for long-term monitoring of the transplanted cornea and overall eye health.

What to Ask Your Doctor

  1. What type of corneal transplant procedure is recommended for my specific condition?
  2. What are the potential risks and complications associated with the procedure?
  3. How long is the recovery period after the surgery?
  4. What post-operative care will be required, and how can I best ensure a successful outcome?
  5. Are there any alternative treatments or procedures that could be considered instead of a corneal transplant?
  6. What is the success rate of the procedure for patients with a similar condition to mine?
  7. Will I need to take any medications or follow a specific regimen after the surgery?
  8. How long will it take for my vision to improve after the transplant?
  9. What can I expect in terms of long-term outcomes and potential need for additional surgeries?
  10. Are there any specific lifestyle changes or precautions I should take after the surgery to protect my eyes and promote healing?

Reference

Authors: Chua A, Chua MJ, Kam P. Journal: Anaesth Intensive Care. 2018 Mar;46(2):162-170. doi: 10.1177/0310057X1804600204. PMID: 29519218