Banana Patch Graft in Mooren's Ulcer | Cornea Colours | Season 2 скачать в хорошем качестве

Banana Patch Graft in Mooren's Ulcer | Cornea Colours | Season 2

Peripheral ulcerative keratitis (PUK) is an inflammatory, necrotic condition in the peripheral cornea which may end in corneal perforation and visual morbidity if not treated adequately. PUK can occur due to infectious or non-infectious causes. Early cases need medical therapy, both locally and systemically (for some cases). However, advanced PUK may necessitate surgical removal of inciting cause of the pathology and maintaining tectonic stability. Such surgical treatment includes Conjunctival resection, Conjunctival flap Cryotherapy, Diathermy coagulation, Amniotic Membrane Graft, Corneal Patch graft, and Penetrating Keratoplasty. Here we will discuss about Corneal Patch graft(Banana Patch graft) Following are the Surgical steps: 1. Host Bed Preparation -Epithelial debridement was done with 15 No. blade -Keratectomy was done with curved corneal scissors to remove the active margin -Scleral and corneal pockets were made with crescent knife to identify the edematous/infiltrated areas to be excised -Excess corneal tissue was excised in the active area to achieve healthy and clear edge of recipient -Viscoelastic was injected to push the iris back Step 2: Banana Patch Graft preparation A. Measurement of dimensions (Trephine diameter for both curves; Maximum Distance between both curves) B. Punch and hand fashioning -The outer and inner diameter of corneal defect was measured by gently placing various diameter trephine on both edges -The outer and inner diameters were corresponding to 10mm trephine size -Maximum width of the dissected area measured with calliper(3mm) -To make the graft, donor tissue was punched with 10mm trephine -Tissue was placed on flat side of teflon block -Desired width of graft(3.5mm,on higher side) measured and marked with calliper -Desired trephine was placed at inner margin and punched 3. Suturing -Trephined tissue placed over dissected area -Initial stay suture taken at the outer margin on the limbal side at 9 o'clock -Principle of suturing is same as that of Penetrating Keratoplasty -Next suture was taken adjacent to it -The primary suture was taken on the other side -Initial sutures help in securing the graft in proper orientation -Extra donor tissue at the inferior apex was trimmed and hand fashioned so that edges matched with host size and shape -Suturing of the inferior apex was done -The rest of the sutures were placed between the primary suture so as to maintain the proper contour and aesthetics of the graft ensuring graft-host junction apposition -Suturing was completed at the nasal side -The viscoelastic substance was injected -Superior apex was similarly hand fashioned -Sutures were passed perpendicular at the GHJ with principles same as Penetrating Keratoplasty -AC was formed with saline and water tightness of Graft-host junction was checked with dry merocel sponge -Suture knots were buried away from the pupillary axis -BCL was placed at the end of the surgery Disclaimer: This video is meant for the education of eye specialist. The treatment should be done by ophthalmologist based on own clinical judgment.