2 results
102 - Corneal transplantation
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- By C. Diane Song, Emory University, School of Medicine, Atlanta, GA, Enrique Garcia-Valenzuela, Emory University, School of Medicine, Atlanta, GA, G. Baker Hubbard III, Emory University, School of Medicine, Atlanta, GA, Thomas M. Aaberg, Sr., Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 700-701
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- Chapter
- Export citation
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Summary
Corneal transplant, also known as penetrating keratoplasty, has a 90% success rate as defined by clear grafts in 1 year. The primary indication for the procedure is a hazy or opaque cornea causing decrease in vision. The etiologies of corneal opacities include congenital defects, hereditary dystrophies, infection, and trauma. Occasionally, corneal transplants are performed simultaneously with cataract surgery, intraocular lens exchange, or with posterior segment surgery, depending on other conditions affecting vision. The procedure is not as common as lamellar keratoplasty, in which only the anterior surface of the cornea is grafted, leaving the posterior surface intact.
For most patients, the operation is performed on an outpatient basis under local anesthesia with monitored anesthesia care. Under special circumstances, a patient may require general anesthesia and overnight stay in the hospital. Depending on whether or not other intraocular surgeries are performed at the same time, the operation lasts between one half to two hours and involves removing the patient's hazy cornea and replacing it with a clear donor cornea that is sewn in place with nylon sutures. It is performed under an operating microscope and requires the patient to lie still. When the operation is complete, the patient is given topical medications and the eye should be patched overnight. Blood loss is minimal to none during the procedure.
Usual postoperative course
Expected postoperative hospital stay
Most patients go home on the day of surgery.
Operative mortality
Extremely low and generally associated with the anesthetic used.
105 - Refractive surgery
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- By C. Diane Song, Emory University, School of Medicine, Atlanta, GA, Enrique Garcia-Valenzuela, Emory University, School of Medicine, Atlanta, GA, G. Baker Hubbard III, Emory University, School of Medicine, Atlanta, GA, Thomas M. Aaberg, Sr., Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 706-707
-
- Chapter
- Export citation
-
Summary
Done to reduce dependence on glasses or contact lenses, refractive surgery involves reshaping the cornea with incisions, heat, or laser to decrease myopia, astigmatism, or hyperopia. Presently, the most frequently performed refractive surgical procedure is laser-assisted in situ keratomileusis (LASIK).
LASIK can correct refractive error within a wide range. To deduce whether LASIK is a good option for a patient, a thorough preoperative eye exam is necessary. Indications may include intolerance to contact lenses, improved conditions for job-related or hobby-related activities, or a desire to lessen reliance on glasses and contact lenses.
Performed in an outpatient setting with topical anesthesia, the operation usually lasts about 15 minutes with the patient experiencing minimal discomfort. Both eyes may be operated on the same day. After it is cut, the thin corneal flap is lifted and reflected to allow the laser to reshape the cornea. The laser is programmed with the patient's refractive error; once that refractive error is corrected, the corneal flap is realigned into place.
Usual postoperative course
Expected postoperative hospital stay
Most surgeries are performed in a surgicenter on an outpatient basis.
Special monitoring required
The patient's eyes are generally not patched, though sunglasses may be necessary if there is sensitivity to light. Discomfort is minimal postoperatively.
Patient activity and positioning
Most patients will be able to see well enough on the first postoperative day to return to regular activity, though they require reading glasses for near vision if they are in the presbyopic age range.