Corneal Transplantation

Mea A. Weinberg, DMD, MSD, RPh; Michael S. Insler, MD; Floyd L. Dussetschleger, DDS; Abraham Insler

US Pharmacist

Conclusion

Corneal transplantation has undergone enormous improvements in surgical techniques and eye banking during the past 50 years, making it one of the most successful forms of organ replacement. The advent of new procedures, such as DSAEK, has greatly shortened the recovery period, and bioengineering breakthroughs are beginning to show promise for synthetic corneas. Finally, refinements in drug delivery and potency are being used successfully to improve outcomes following graft rejection.

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Cite this: Corneal Transplantation - Medscape - Apr 01, 2011.

Table 1. Common Corneal Diseases and Conditions Requiring Transplantation
Keratoconus: progressive thinning and bulging of the cornea Fuchs' dystrophy: hereditary malfunction of the inner layer (endothelium) of the cornea, causing corneal cloudiness and leading to vision loss Keratitis (inflammation of the cornea) resulting in a corneal scar Pseudophakic bullous keratopathy: corneal swelling after cataract surgery with intraocular lenses Peters' anomaly: congenital opacity in children <5 y Corneal scarring caused by viral (ocular herpes, herpes zoster), bacterial, or fungal infections or by corneal injury (mechanical trauma, chemical burns) Corneal dystrophy: hereditary stromal disorders causing loss of clarity from development of abnormal cloudy material Regrafting: reoperation after previous graft failure

Source: References 3, 4.

Table 2. Medications Used After Corneal Transplantation
Medication	Dosage	Use
Sodium chloride 2%, 5% (Muro 128)	Solution—1–2 gtt q1h in affected eye until noon (4–5 times); then several times prn over rest of day; ointment—0.25" in affected eye hs	Controls water distribution and osmotic pressure in eye
Polymyxin/trimethoprim (Polytrim drops/Polysporin ointment)	Adult: solution—1–2 gtt q2h in affected eye while awake; ointment—0.5" ribbon in conjunctival sac qid and/or hs Pediatric: <2 mo, not established; >2 mo, adult dosage	Prevents bacterial infection
Moxifloxacin (Vigamox 0.5%)	Adult, pediatric: 1 gtt tid	Prevents bacterial infection
Prednisolone acetate suspension 1% (Pred Forte) or prednisolone phosphate solution 1% (Inflamase Forte)	Adult, pediatric: solution—1–2 gtt in conjunctival sac q1h during day and q2h hs; once desired response obtained, 1 gtt q4h; may reduce to 1 gtt tid-qid to control symptoms; suspension—shake well before using; 1–2 gtt in conjunctival sac bid-qid; if necessary, increase frequency during initial 24–48 h	Reduces inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability
Brimonidine (Alphagan 0.15%, 0.2%)	Adult: 1 gtt in affected eye tid Pediatric: not established	Decreases intraocular pressure
Timolol (Timoptic 0.25%, 0.5%)	Adult, pediatric: 1 gtt in affected eye(s) bid	Decreases intraocular pressure
Polyethylene glycol 400 0.4% and propylene glycol 0.3% (Systane)	Adult, pediatric: 1 gtt q1-2h for first 1–2 days postsurgery, then prn	Moisturizes and lubricates eye

Source: Reference 23

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Corneal Transplantation

Conclusion

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

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