Partnerships for Success Corneal Transplant in the 21

Objectives • Understand the importance of good eye care • Recognize the benefits of

Question to Run on • How do your actions in the hospital affect the

The Basics The goal of the cornea is to focus light to a point

What two requirements are necessary for the cornea to perform this function? Transparency and

Corneal Anatomy • Epithelium- 50 microns • Bowman’s Layer- 12 microns • Stroma- 450

Suturing Healthy Donor Tissue into Place

Corneal Dystrophy Treated with Excimer Laser

Deep Lamellar • Replacing Descemet’s and Endothelial layer • Difficult dissection technique for both

Descemet’s Stripping • Manual Dissection-host and donor • Automated -donor

Intra. Lase Enabled Keratoplasty The Intra. Lase Enabled Keratoplasty software can be programmed to

Intra. Lase Enabled Keratoplasty The Intra. Lase® FS ophthalmic surgical laser is cleared for

Intra. Lase Enabled Keratoplasty The Intra. Lase Enabled Keratoplasty application allows the user to

The Intra. Lase Enabled Keratoplasty application allows the user to perform three cut segments:

Cut Angles Red Blue Yellow Dotted line 90 degrees 30 degrees 150 degrees angle

Key Elements in Caring for Potential Donors • Making the Referral • Approach for

Making the Referral • Report all imminent/cardiac deaths within ONE HOUR • Regardless of

Why? • Allows time to serve the family • Preserves organ and tissue viability

Approaching for Donation • Most deaths will not be eligible for donation • Do

Maintain Opportunity for Corneal Donation • Ventilated or comatose patients- lubricate eyes frequently :

Partnerships for Success: Corneal Transplant in the 21 st Century Jessica Horton Respiratory Therapist

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Partnerships for Success: Corneal Transplant in the 21 st Century Breakout Session A Presenters: Christopher Blanton, MD Medical Director, Ocular Services, One. Legacy Jessica Horton Respiratory Therapist & Cornea Recipient, Antelope Valley Hospital Moderator: Sherri Lamon, RN, PIH Health

Objectives • Understand the importance of good eye care • Recognize the benefits of timely referrals • Be aware of indications for corneal transplant and innovative remedies.

Question to Run on • How do your actions in the hospital affect the gift of sight?

The Basics The goal of the cornea is to focus light to a point on the retina.

What two requirements are necessary for the cornea to perform this function? Transparency and correct shape

Corneal Anatomy • Epithelium- 50 microns • Bowman’s Layer- 12 microns • Stroma- 450 -900 microns • Descemet’s membrane- 3 -12 microns • Endothelium- 4 -6 microns

Corneal Anatomy

Corneal Transplant Surgery

Trephine of Donor Tissue

Initial Incision into Eye

Removal of Diseased Corneal Tissue

"Open Sky" Portion of Surgery

Sewing donor tissue into place

Suturing Healthy Donor Tissue into Place

Pseudophakic Bullous Keratopathy

Bullous Keratopathy-Fuchs' Dystrophy

Endothelial Disease

Failed Corneal Transplant

Keratoconus

Keratoconus – Advanced

Corneal Scar

Corneal Scar – High Mag

Corneal Scar Infectious Viral

Corneal Scar – Infectious Bacterial

Corneal Perforation

Corneal Dystrophies

Corneal Dystrophy Treated with Excimer Laser

Chemical Burn

Partial Thickness • DLEK • DSAEK

Deep Lamellar • Replacing Descemet’s and Endothelial layer • Difficult dissection technique for both donor and host cornea

Descemet’s Stripping • Manual Dissection-host and donor • Automated -donor

DSAEK Graft

Intra. Lase Enabled Keratoplasty The Intra. Lase Enabled Keratoplasty software can be programmed to produce different configurations with computer precision. Historical use of trephination utilizing different shapes has taught us that different configurations have unique features that can be used for specific indications.

Intra. Lase Enabled Keratoplasty The Intra. Lase® FS ophthalmic surgical laser is cleared for the creation of a lamellar cut/resection of the cornea for lamellar keratoplasty and for the creation of a PENETRATING CUT/INCISION for penetrating keratoplasty The Intra. Lase FS surgical laser can perform the following cuts that when combined at different angles can create various geometrically shaped corneal resections at the surgeon’s desired depth.

Intra. Lase Enabled Keratoplasty The Intra. Lase Enabled Keratoplasty application allows the user to perform three cut segments: a posterior side cut, lamellar cut, and anterior side cut.

The Intra. Lase Enabled Keratoplasty application allows the user to perform three cut segments: a posterior side cut, lamellar cut, and anterior side cut.

Cut Angles Red Blue Yellow Dotted line 90 degrees 30 degrees 150 degrees angle measurement

Example Pattern Combinations

Actual Surgery

OCT of Standard PK

OCT of Zig-Zag IEK

Key Elements in Caring for Potential Donors • Making the Referral • Approach for Donation • Maintain the Opportunity • Ventilated or Comatose Patients

Making the Referral • Report all imminent/cardiac deaths within ONE HOUR • Regardless of medical condition, age, advanced directive • HIPAA compliant

Why? • Allows time to serve the family • Preserves organ and tissue viability • Ensures compliance with federal and state laws

Approaching for Donation • Most deaths will not be eligible for donation • Do not approach independently of One. Legacy. • Have medical chart available for One. Legacy to determine suitability. • LNOK contact information

Maintain Opportunity for Corneal Donation • Ventilated or comatose patients- lubricate eyes frequently : every 4 -6 hours gel is better than tears • Deceased patients- wait for go ahead from One Legacy: eye care may interfere with M. E. /coroner's investigation.

Poor Eye Care Can Damage the Cornea

Healthy Donor Tissue Cures Blindness

Partnerships for Success: Corneal Transplant in the 21 st Century Jessica Horton Respiratory Therapist & Cornea Recipient Antelope Valley Hospital

Question to Run on • How do your actions in the hospital affect the gift of sight?

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