Name of the Procedure:

Anesthesia for procedures on eye; corneal transplant
Common name(s): Corneal Transplant Anesthesia, Keratoplasty Anesthesia
Medical term: Penetrating Keratoplasty Anesthesia

Summary

During a corneal transplant, anesthesia is administered to ensure the patient experiences no pain or discomfort. Anesthesia can be either general or local, depending on the patient's condition and the surgeon's preference. This allows the surgeon to replace the damaged cornea with a healthy donor cornea effectively.

Purpose

The purpose of anesthesia in a corneal transplant is to:

• Prevent pain and discomfort during the surgery
• Keep the patient still and relaxed for optimal surgical conditions
• Ensure the safety and efficacy of the corneal transplant procedure

Indications

This procedure is indicated for patients requiring a corneal transplant due to:

• Corneal scarring
• Keratoconus
• Corneal ulcers or infections
• Fuchs' dystrophy
• Corneal edema or swelling

Preparation

• Patients are typically instructed to fast (no food or drink) for at least 6-8 hours before the procedure if general anesthesia is planned.
• Medications may need to be adjusted or temporarily halted, as advised by the surgeon and anesthesiologist.
• Pre-operative assessments may include blood tests, ECG, and a review of medical history.

Procedure Description

• Local Anesthesia: Anesthetic eye drops or injections are administered to numb the eye.
• General Anesthesia: Intravenous (IV) drugs and inhalation agents induce unconsciousness so that the patient remains asleep and free from pain during the procedure.
• Specialized equipment includes eye speculums, microscopes, and surgical instruments for corneal transplantation.
• Continuous monitoring of vital signs is performed by the anesthesia team.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is performed in an outpatient surgical center or hospital operating room.

Personnel

• Ophthalmic Surgeon
• Anesthesiologist or Nurse Anesthetist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Common Risks: Eye discomfort, temporary blurred vision, nausea, and minor bleeding.
• Rare Risks: Allergic reaction to anesthetic agents, infection, anesthesia-related complications such as respiratory issues, and prolonged recovery from anesthesia.

Benefits

• Allows for a painless and stable environment for the corneal transplant
• Facilitates rapid recovery and improved vision post-transplant

Recovery

• After local anesthesia, patients may go home the same day with prescribed eye drops.
• General anesthesia may require a short stay in a recovery area for monitoring until the patient is fully awake.
• Follow-up appointments are essential to monitor healing and vision improvement.

Alternatives

• Corrective lenses or contact lenses: For mild to moderate corneal issues
• Corneal cross-linking: For conditions like keratoconus
• Artificial cornea (keratoprosthesis): In cases where a traditional transplant is not possible

Patient Experience

• During the Procedure: If under local anesthesia, a sense of pressure might be felt but no pain; under general anesthesia, the patient will be asleep.
• Post-procedure: Some discomfort, mild pain, and blurred vision are expected; pain management with medications and eye drops will be provided.
• Comfort measures include wearing a protective eye shield and avoiding strenuous activities during the initial recovery period.