Montana (MT) Keratoplasty

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There are three types of Keratoplasty. One is standard Keratoplasty, which is corneal grafting or transplantation. The second is Lamellar Keratoplasty, which is corneal grafting of partial thickness. The last is Penetrating Keratoplasty for corneal grafting of full thickness. For successful Keratoplasty, the donor tissues must be removed from the cadaver within 6 hours after the occurrence of death. The removed corneo-scleral button could be stored only for about 2 weeks at the maximum.

The plastic surgery of Keratoplasty should be done only experienced and skilled surgeons. The surgeon would first decide about the graft size, which would normally be about 7.5 mm. Grafts bigger than 8.5 mm could lead to increase in anterior synechiae, intro-ocular pressure, and vascularzation. Smaller sizes could result in astigmatism because of tissue tension. The donor button should be about 0.5 mm bigger than the planned opening of the recipient.

In this complicated eye surgery, the surgeon would miose the pupils to protect the lens and avoid cataract. After that, trephination would be done. The surgeon would then proceed with a partial thickness cut before performing a full thickness trephination. This would be followed by four cardinal sutures at three, six, nine, and twelve o’clock positions. These sutures would be interrupted sutures. Finally, running and interrupted sutures would be applied according to specific requirements.

The risk in Keratoplasty is graft failure due to defective donor endothelium, trauma, or immune graft rejection. The first two would occur immediately after the eye surgery cosmetic procedure but the third would occur within 6 months to one year after the surgery. This could be remedied by hourly tropical steroids or by periocular steroid injections. Other complications in Keratoplasty would be persistent epithelial defects, flat anterior chamber, infection, cystoid macular edema, astigmatism, and glaucoma. The surgeon should closely monitor the patients for about a year after Keratoplasty.