This document discusses various corneal surgeries including keratectomies and conjunctival grafts. It covers the surgical anatomy of the cornea, corneal healing, preparation for surgery, and materials used. Superficial keratectomies are described as well as indications, techniques, results, follow-up and complications. Punctuate and grid keratotomies are also outlined. Finally, the document discusses conjunctival grafts including types, practical realization, follow-up, and potential complications.

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CORNEAL SURGERY
Dr Frank FAMOSE
DVM, CES Ophtalmologie
Ekaterinburg May 2010
Surgical anatomy of cornea
►Precorneal tear film
►Epithelium
►Stroma
►Descemet’s
membrane
►Endothelium
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Corneal healing
►Avascular healing ►Edema
►Vascular healing ►Vascularisation
►Scar formation
►Pigmentation
►Degeneration
Corneal preparation
► Hair clipping
►Desinfection
►Draping
►Ocular fixation
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Corneal surgery : microscope
Corneal surgery : material
►Cutting knives
►Disposable
►Blade-holders
►Dissection knives
►Trephines
►Scissors
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Corneal surgery : material
►Grasps & forceps
►Needle-holder
►Suture material
KERATECTOMIES
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Indications : superficial corneal
diseases
►Corneal dermoïds
►Corneal lipidosis
►Recurrent corneal
erosions
►Feline corneal
sequestra
Corneal surgery : keratectomies
►Technical aspects ►Indications
 Superficial
keratectomy
►Practical realisation
 Superficial
keratotomy ►Results
 Corneal biopsy ►Follow-up
►Complications
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Superficial keratectomy :
indications
►Corneal dermoïds
►Corneal lipidosis
►Feline corneal
sequestra
►Inflammatory
keratopathies
Superficial keratectomy : practical
realisation
►Corneal incision
►Stroma dissection &
separation
►Removal of corneal
parts
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Superficial keratectomy : results
►Transparency
►Vascular invasion
►Pain
►Pigmentation
Superficial keratectomy : Follow-
up
►Post-operative
treatment
 Local antibiotics
 Local corticosteroïds ?
►Follow-up
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Superficial keratectomy :
complications
►Infection
►Fibrosis
►Delayed healing
►Pigmentation
Punctuate and grid keratotomy :
indications
►Non healing
superfical corneal
ulcers in dogs
►R/O other causes
►Not in cats
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Punctuate and grid keratotomy :
practical realisation
►Epithelial
debridement
►Anterior stromal
keratotomy
►Corneal protection
Punctuate and grid keratotomy :
results
►Epithelial healing
►Vascular invasion
►Pain
►Pigmentation
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Punctuate and grid keratotomy :
Follow-up
►Ulcer healing
►Medical
treatment
Punctuate and grid keratotomy :
complications
►Non-healing ulcers
►Corneal granuloma
►Deep stromal
inflammation
►Corneal scars
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CONJUNCTIVAL
GRAFTS
Indications
►Deep corneal
defects
►Ocular
perforation
►Keratomalacia
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Types of conjunctival grafts
►Pedicule
►Island graft
►Bridge
►Complete
Practical realization
►Corneal preparation ►Debridement
►Sepsis treatment
►Graft preparation ►Subconj. injection
►Suture
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Practical realization : pedicle
►Indications
 Central
 Paracentral
►Difficulties
►Graft’s dimensions
►Tension
Practical realization : island
►Indications
►Central
►Paracentral
►Difficulties
►Manipulation of graft
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Practical realization : complete
►Indication
 Large central
 Multiple lesions
 keratomalacia
►Difficulties
 No corneal
visualisation
Follow-up
►Sutures ►D2 to D10
►Tissue Retraction ►D7
►Leakage (if perforated) ►D2xxxxxxxxxxxxxxx
xx
►Removal of pedicle
►D21
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Complications : causes
►Sutures or knots ►Excessive tension
failure or stretching
►Incomplete covering ►Wound infection
►Leakage ►Incomplete
preparation of
►Oblic graft direction cornea
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Conclusion
►Surgical rules and material
►Simple techniques for keratectomy
►Many technical possibilities with conjunctival
grafts
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