Name of the Procedure:

Backbench Preparation of Corneal Endothelial Allograft Prior to Transplantation
(Commonly also referred to as "preparing a donor cornea" or "corneal allograft preparation")

Summary

This procedure involves preparing a donated corneal tissue, specifically the endothelial layer, in order to make it ready for transplantation into a recipient's eye. This step is performed before the actual transplant surgery to ensure that the donor tissue is in optimal condition for grafting.

Purpose

The procedure addresses conditions affecting the corneal endothelium, such as Fuchs' dystrophy or bullous keratopathy. The goal is to replace damaged or diseased endothelial cells with healthy ones from a donor, thereby restoring clear vision and corneal function.

Indications

• Progressive vision loss due to Fuchs' endothelial dystrophy.
• Corneal swelling (edema) from endothelial cell failure.
• Bullous keratopathy.
• Failed previous corneal transplant.

Preparation

• Patients may be advised to stop taking certain medications.

• Pre-procedure assessments include a complete medical history, eye examination, and sometimes imaging studies of the cornea.

  Procedure Description

  1. The donor cornea is carefully inspected under a microscope.
  2. The endothelial layer, along with a thin layer of stroma, is meticulously separated from the rest of the cornea using precision instruments.
  3. The prepared endothelial graft is placed in a solution to maintain its viability.
  4. The prepared graft is trimmed to the desired size.
  5. The tissue is then stored in a sterile, nutrient-rich medium until the time of transplantation.

  Tools and equipment used include microscopes, trephines, and specialized surgical instruments. Typically, this procedure is done without the patient being present, so anesthesia or sedation is not required.

Duration

The preparation procedure typically takes about 30 to 60 minutes.

Setting

Usually performed in an eye bank or specialized ophthalmology laboratory.

Personnel

• Ophthalmic surgeons or eye bank technicians with specialized training.
• Support staff such as medical technologists.

Risks and Complications

• Risk of contamination leading to infection.
• Potential damage to the endothelial cells during preparation.
• Rarely, donor tissue may be inadequate for transplantation and another donor must be found.

Benefits

• High-quality preparation can improve the success rate of corneal endothelial transplantation.
• Significantly restores vision and improves corneal clarity.

Recovery

• Since the preparation is done prior to transplantation, recovery pertains to the transplantation procedure itself.
• Following the actual transplantation, typical recovery involves several weeks with follow-up visits to monitor healing and ensure graft viability.

Alternatives

• Full-thickness corneal transplant (penetrating keratoplasty).
• Non-surgical options like contact lenses or medication to manage symptoms, though these are less effective for severe endothelial dysfunction.

Patient Experience

Patients usually do not experience the allograft preparation itself as it is done separately. During transplantation, patients might experience mild discomfort, but pain management strategies are employed, including the use of anesthesia. After the transplantation, typical sensations include mild irritation and sensitivity which generally subside with proper post-operative care.