optical lamellar keratoplasty

Laminar keratoplasty (LK) is a partial thickness keratoplasty. After excising the lesion tissue of the corneal wound, the corresponding thickness of the graft is transplanted onto the implant bed. If necessary, only the posterior elastic membrane and the endothelial layer can be left. For deep lamellar keratoplasty. Treatment of diseases: posterior pleomorphic corneal dystrophy Indication The lesion does not involve the deep stromal layer and the posterior elastic layer of the cornea, and the endothelial cells function normally: 1. Shallow scarring opacity in the central area of the cornea, preferably <6mm in diameter. 2. Each of the middle and shallow corneal dystrophy. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation 1 Check the patient's operation of the eye according to the medical record, pay attention to the left and right eyes, upper and lower jaws, and surgical methods. 2 patients on the supine surgery table. 3 When the surgical eye needs to be surface anesthetized, 0.5% tetracaine (dicaine) can be dripped, 1 drop each time, once every 2-3 minutes, for a total of 3 times. The lacrimal passage exploration technique uses a small cotton swab to lick 0.5% tetracaine and then clips it into the inner corner, and can take a seat without disinfection. 4 According to the type of surgery, the following methods can be used to clean and disinfect: clean the eyelid skin with soapy water, rinse the conjunctival sac with 0.02% benzalkonium bromide (new chlorhexidine) solution or 1:5000 chlorhexidine solution, and then disinfect with 75% ethanol. Area skin, and finally cover the surgical towel or hole towel. Surgical procedure 1. Make a transplant bed: open the device and open the upper and lower rectus muscles to fix the suture. You can use any kind of trephine for penetrating keratoplasty. The diameter of the bed is generally 7.5~8mm. A depth of 0.3 to 0.4 mm is drilled in the central region of the cornea. 2. The corneal tissue is clamped with a microscopic single-toothed file and can be cut with a 5th round knife. The sectioning is performed along the same corneal fiberboard layer to maintain a uniform depth. 3. Make a transplant: You can choose the same method as the transplant bed, take the eyeball preserved in the wet room or glycerin, and peel off the lamellar cornea of the required size. The diameter is generally 1 mm larger than the plant bed. 4. In order to make the refractive interface smoother, it is also possible to use a full-thickness full-thickness corneal membrane of a refrigerated lathe, with the epithelium facing down, placed on the cutting drill, and the platoon graft of the desired size is cut with a trephine. 5. Suture the graft: Place the graft on the plant bed and suspend or continuously suture the 10-0 nylon thread on the transplant bed. The method is the same as penetrating keratoplasty. The last gentamicin 20,000 units, dexamethasone 2.5mg subconjunctival injection, including both eyes.