DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Pseudophakic bullous keratopathy, right eye.
POSTOPERATIVE DIAGNOSIS: Pseudophakic bullous keratopathy, right eye.
OPERATION PERFORMED: Corneal transplant, endothelial keratoplasty technique, right eye.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATIONS FOR OPERATION: Decreased visual acuity and corneal edema.
DESCRIPTION OF OPERATION: The patient was brought to the operating suite and placed in the supine position. After induction of general anesthesia, the patient was prepped and draped in the usual sterile fashion, and the donor cornea was brought into place on a side table, found to be suitable, and was placed on a Moria artificial anterior chamber and the chamber was inflated and the pressure was noted to be about 65 mmHg. The Moria ALTK unit with a 300 micron head was used to remove the anterior portion of the donor cornea. This anterior portion then was placed back on top of the donor cornea, and the entire donor cornea was placed in a well with Optisol solution.
Attention was then turned to the patient’s eye where a 5 mm limbal groove was made at a depth of 350 microns. A scleral tunnel was then performed, and the anterior chamber was entered. Two stab incisions were placed at the 3 and 9 o’clock positions. Healon was instilled in the anterior chamber. A reverse Sinskey hook was used to score the cornea at the 8 mm mark, and the Descemet’s membrane and endothelium were removed.
The donor cornea was then taken out of the Optisol and placed in a Hessburg-Barron punch after the anterior 300 micron portion of cornea was removed. A remodeled button was punched. This button was then taken, folded over taco style in a 60/40 fashion. This was then inserted into the anterior chamber using Utrata forceps. An air bubble was then used to open up the donor cornea and to force it to adhere to the recipient cornea. The Healon had been removed from the anterior chamber prior to placement of the donor cornea.
Three interrupted 10-0 nylon sutures were used to close the 5 mm wound. Most of the air bubble was removed replacing this with BSS; however, a 6 to 7 mm air bubble was left in place, and the patient was instructed to lie on the back for the entire evening. Vigamox drops were applied to the eye. The cornea was precut by the eye bank, and two 10-0 nylon sutures were used to secure the graft in place. The donor size was 7.25 mm. The patient was delivered to the recovery area in stable condition.
