bridge penetrating keratoplasty

1. Herpes simplex keratitis active or purulent corneal infection, drug treatment is ineffective, have to undergo penetrating keratoplasty. 2. Large corneal perforation or corneal fistula, no anterior chamber before surgery. 3. The cases of macrophage keratopathy and endothelial dysfunction caused by some thicker implants than the grafts can reduce the complications of membrane, iris or vitreous and graft adhesion, and improve the transparency of the graft. Treating diseases: keratitis Indication 1. Herpes simplex keratitis active or purulent corneal infection, drug treatment is ineffective, have to undergo penetrating keratoplasty. 2. Large corneal perforation or corneal fistula, no anterior chamber before surgery. 3. The cases of macrophage keratopathy and endothelial dysfunction caused by some thicker implants than the grafts can reduce the complications of membrane, iris or vitreous and graft adhesion, and improve the transparency of the graft. Contraindications 1. Glaucoma: If the preoperative diagnosis of glaucoma is confirmed, penetrating keratoplasty must be performed after drug, laser or anti-glaucoma surgery is effectively controlled. 2. Dry eye syndrome: Substantial dryness of the knot and cornea may make it difficult to heal the epithelium after penetrating keratoplasty, which may lead to turbidity of the graft. Therefore, for patients with ocular disease, surgery must be performed after rebuilding the ocular surface and tear secretion for >10 mm/5 min. 3. Intraocular active inflammation: such as uveitis, suppurative endophthalmitis, etc. should not be operated. If suppurative endophthalmitis is formed due to corneal penetrating injury, the corneal transparency is not sufficient, and penetrating transplantation combined with vitrectomy can be performed. 4. Paralytic keratitis: This disease is caused by corneal opacity caused by corneal dystrophy, and it is not suitable for surgery before the primary disease is cured. 5. Retinal and visual dysfunction: amblyopia, severe retinopathy, optic atrophy, or other damage to the visual pathway is not suitable for surgery. If you are a cosmetic request, you can consider cosmetic keratoplasty. 6. Auxiliary suppurative inflammation: such as chronic dacryocystitis, ulcerative bursitis, etc., to be treated with penetrating keratoplasty after the suppurative infection is cured. 7. The patient's general condition cannot tolerate ophthalmic surgery: patients with severe hypertension, heart disease and diabetes, should be considered for penetrating keratoplasty after effective medical treatment. 8. Acquired immunodeficiency disease (AIDS): penetrating keratoplasty is not possible. 9. One-eyed vision>0.2. Preoperative preparation 1. The patient has 0.3% norfloxacin eye drops 1 to 2 days before surgery. 2. 0.25% ecsigmine eye ointment on the night before surgery, or 1% pilocarpine eye drops 2 times before surgery. 3. Infectious keratopathy as a pathogen test (smear test + culture). 4. Chemical burns were examined for tear film rupture time and tear secretion test. 5. Wear through the injury to do b-ultrasound or x-ray film. 6. One hour before surgery, 0.5 g of acetazolamide and 5 mg of diazepam, and 20% of mannitol (4 ml/kg) in children. Surgical procedure 1. Take the graft, generally not less than 7mm, because the 7mm plant often has a 1mm annular turbid belt. 2. The graft hole is slightly larger than the lamellar implant with a corneal lesion depth of 3/4 (near posterior elastic layer). The trephine with a diameter of 1 to 2 mm smaller than the front implant hole is drilled through the slab layer in the center of the slab bed, or only a part of the slab is drilled through the corneal scissors. 3.10-0 nylon thread continuous or intermittent suture.