DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Keratoconus, left eye.
2. Pellucid marginal degeneration, left eye.
OPERATION PERFORMED:
Corneal transplant (penetrating keratoplasty), left eye.
SURGEON: John Doe, MD
ANESTHESIA:
General endotracheal.
COMPLICATIONS:
None.
ESTIMATED BLOOD LOSS:
Less than 5 mL.
DESCRIPTION OF OPERATION:
After informed consent had been obtained, the patient was taken back to the operating room where cardiac and blood pressure monitoring devices were applied. The patient underwent general anesthesia and then was prepped and draped in the usual sterile fashion for a penetrating keratoplasty of the left eye.
A lid speculum was inserted and the cornea was inspected. There appeared to be an ectatic central protuberance of the cornea with inferior steepening, thinnest approximately 2 mm below the corneal anatomic center. The corneal dome was elevated from approximately normal depth of 4 mm to approximately 6 mm. The corneal central was marked with a sterile marking pen and an 8.5 mm trephine was used to pick a proposed location for the corneal transplant.
Next, a radial keratotomy marker was used to mark the quadrants in 12 meridians. Next, a Flieringa ring was sewn to the sclera with 5-0 Dacron suture. Next, the corneal donor button was prepared with a vacuum punch measuring 8.5 mm. This was covered in viscoelastic and placed aside for the time being. Sample of the fluid that the donor cornea arrived in and the remainder of the donor tissue was sent for microbiology. Next, the vacuum trephine was applied to the patient’s cornea. This was an 8.5 mm vacuum trephine, and it was advanced until a small gush of aqueous came inferiorly.
Next, Healon was used to restore the anterior chamber depth and to provide space between the iris and the cornea. The patient’s cornea was removed using an eye knife to make a vertical paracentesis incision and then continued with corneal scleral scissors to remove the host button. The host button was then sent for pathology. The donor button was then carefully placed. The cardinal sutures were placed at 12, 3, 6, and 9 o’clock with 10-0 nylon sutures. After the cardinals were secured, additional sutures were placed in each clock hour for a total of 12 interrupted sutures.
Because of the lack of thickness in the host cornea inferiorly, as well as to reduce postoperative myopia, decision was made to use a 24 interrupted suture technique and 12 additional sutures were placed between the original clock hours. Once all 24 sutures were placed, the anterior chamber was reinflated with Healon and tension on each suture was tested. All loose sutures were removed and replaced. All nonradial sutures were removed and replaced. Once all 24 sutures had been successfully placed, the Healon was irrigated from the anterior chamber using BSS on a 27-gauge cannula. The cornea was then dried with a Weck-cel sponge and fluorescein testing demonstrated a small leak between the 6 and 6:30 sutures. The 10-0 nylon was used to create one more additional pass at 6:15, which stopped the leak. The Flieringa ring had been removed prior to removing the Healon.
Once the wounds were all deemed to be Seidel negative, the surface was irrigated and the patient was given an additional injection of 0.1 mL of 10 mg/mL vancomycin sterile solution and BSS. The lid speculum was removed and a drop of Alphagan, timolol, and Pilopine gel were all applied to the left eye, which was patched and covered with an eye shield, which was taped in place. The patient was then extubated and taken to the recovery area in good condition without any immediate apparent complications.
