Surgical Anatomy for Endothelial Keratoplasty

  • Soosan Jacob

Your browser needs to be JavaScript capable to view this video

Try reloading this page, or reviewing your browser settings

You're watching a preview of subscription content. Log in to check access

The video discusses the surgical anatomy of the cornea with a special reference to endothelial keratoplasty. It focuses on each of the 6 layers of the cornea and emphasizes specially on the newly described Pre-Descemet’s Layer or the Dua’s Layer. The video elaborates on the significance of the Pre-Descemet’s layer in the creation of the Type 1 and Type 2 big bubbles. It also discusses the normal structure of the endothelium. It includes illustrations and images, and lucid commentary to help the viewer understand the concepts.

The video provides necessary understanding about the anatomy of the cornea that is required for successfully performing endothelial keratoplasty and PDEK. It is useful for young as well as established corneal surgeons, post graduate students, fellows and residents interested in the field, all ophthalmologists, optometrists who are keen to expand their knowledge.

Introduction

The video lays a base or foundation for understanding the corneal anatomy with reference to performing endothelial keratoplasty and PDEK.

About The Author

Soosan Jacob

Dr. Soosan Jacob , MS, FRCS, DNB, MNAMS is director and chief, Dr. Agarwal’s Refractive and Cornea Foundation (DARCF) and senior consultant, cataract and glaucoma services, Dr. Agarwal’s Group of Eye Hospitals, Chennai, India. She is a noted speaker widely respected for her innovative techniques and management of complex surgical scenarios. She conducts courses and delivers lectures in numerous national and international conferences; has been the recipient of IIRSI special gold medal, JRS waring medal for editorial excellence, ISRS Kritzinger memorial award, innovator’s award (Connecticut Society of Eye Physicians), ESCRS John Henahan award for young ophthalmologist, AAO international ophthalmologist education award, AAO international scholar award, AAO achievement award, ASCRS Top-Gun instructor award, UKSOS gold medal, AM Gokhale award and oration, Bruce Jackson oration, Harold Stein innovator lecture, Dr. TN Gopinathan Menon memorial oration award, Dr P R Mondal memorial oration award and is also a two time recipient of ASCRS golden apple award. She has delivered keynote lectures at various international and national conferences including the recent (2018) Swiss Society of Ophthalmology annual conference and 2019 annual conference of Ophthalmological Society of Sweden. She has been invited to teach her techniques and innovations by Bascom Palmer Eye Institute, Miami, USA which is the number 1 ranked eye institute in the world.

In addition, Dr Jacob has won more than 50 prestigious international awards for her surgical videos on her innovations and challenging cases at prestigious international conferences in United States and Europe. She has authored 94 peer reviewed publications, more than 200 chapters in 34 textbooks and is editor for 17 ophthalmology textbooks and reviewer for many prestigious journals. She is chair of the multimedia editorial board AAO-ISRS, member ISRS executive committee, associate editor JRS, section editor (refractive surgery) - EyeNet (American Academy of Ophthalmology); council board member – Global Education and Research Society of Ophthalmology; head of cornea committee - Global Education and Research Society of Ophthalmology and is on editorial board of IJO, EyeNet (AAO), EuroTimes, IJKECD, OSN-AsiaPacific, Glaucoma Today, CRST Europe, TNOA-JOSR and Ophthalmology & Therapy.

Dr Jacob has special interest in cutting edge cataract, cornea, glaucoma, complex anterior segment reconstruction and refractive surgery. Her innovations, many of which have won international awards, include anterior segment transplantation, where cornea, sclera, artifical iris, pupil and IOL are transplanted enbloc for anterior staphyloma; suprabrow single stab incision ptosis surgery to enhance postoperative cosmesis; turnaround techniques for false channel dissection during Intacs implantation; glued endo-capsular ring, glued capsular hook and the paper clip capsule stabilizer for subluxated cataracts; stab incision glaucoma surgery (SIGS) as a guarded filtration surgery technique; contact lens assisted crosslinking (CACXL) for safely crosslinking thin keratoconic corneas; endo-illuminator assisted DMEK (E-DMEK), air pump assisted PDEK and host descemetic scaffolding for easier and better surgical results; PrEsbyopic allogenic refractive lenticule (PEARL) inlay for treating presbyopia, corneal allogeneic intrastromal ring segment (CAIRS) for keratoconus and other corneal ectasias; the Jacob modified technique for pre-descemetic DALK as a primary treatment for acute hydrops; sutureless SMILE lenticule assisted resurfacing with interface tattooing for limbal dermoid; white ring sign and the sequential segmental terminal lenticular side cut dissection for safe and effective lenticule extraction in SMILE surgery She has proposed a new classification of descemet’s membrane detachments into rhegmatogenous, tractional, bullous and complex detachments with a suitable treatment algorithm and a new technique of relaxing descemetotomy for tractional descemet’s detachment.

Dr Jacob’s surgeries and surgical techniques have often been editor’s choice in prestigious international ophthalmic websites (AAO/ ONE network, ISRS, Eyetube etc). She has two popular bimonthly columns, “Complications in Cataract and Refractive Surgery” and “Everything you want to know about” in the prestigious Eurotimes magazine published by ESCRS. She is also the first surgeon internationally to be featured in a dedicated webpage by the Eurotimes. She has her own surgical educational YouTube channel: Dr. Soosan Jacob with more than 6000 subscribers. Dr. Jacob is senior faculty for training postgraduate, fellowship and overseas doctors.

Her life and work have been featured on the Ocular Surgery News cover page, “5Q” interview (prestigious cataract and refractive surgery today - CRST), “Sound off” column (CRST) and “One Day in the Life of…” (CRST) and is also the first researcher internationally to be interviewed in the prestigious CRST “Researcher’s Column.”

 

About this video

Author(s)
Soosan Jacob
DOI
https://doi.org/10.1007/978-981-16-3805-3
Online ISBN
978-981-16-3805-3
Total duration
14 min
Publisher
Springer, Singapore
Copyright information
© Producer, under exclusive license to Springer Nature Singapore Pte Ltd. 2021

Related content

Video Transcript

[MUSIC PLAYING]

Hi, I’m Soosan Jacob, director and chief, Dr. Agarwal’s Refractive and Cornea Foundation, Dr. Agarwal’s Eye Hospital, Chennai, India. In this video, I’m going to be talking about the surgical anatomy of the cornea in relation to performing endothelial keratoplasty.

The cornea is an vascular transparent dome of the eye that, together with the tear film, is the primary reflective surface of the eye. It also acts as a barrier to infections, as well as gives structure to the eye. In the adult eye, its horizontal diameter is about 11 to 12 millimeters, and the vertical diameter is about 9 to 11 millimeters, which means that the cornea is a horizontally oval structure.

The normal thickness of the cornea varies according to the zone being thinner centrally and thicker peripherally. The normal central corneal pachymetry is about 530 to 540 microns and is generally the thinnest point. The thickness progressively increases towards the periphery to about 800 to 1,000 microns. Pachymetric measurements can vary slightly, depending on the device used to measure thickness.

The cornea, together with the tear film, contributes to about 2/3 of the total refractive power of the eye. The average power of the cornea is about 43 diopters, with the anterior surface contributing about 49 diopters, and the posterior surface about minus 6 diopters. In terms of radius of curvature, anteriorly, it is 7.8 mm, and posteriorly, 6.5 mm. The normal human cornea is prolate that is flatter in the periphery and steeper centrally. This helps to create an aspheric optical system.

Three unique properties of the cornea are transparency, avascularity, and immunological privilege. Immune privilege for corneal grafts is thought to be due to the avascularity of the host bed, anterior chamber-associated immune deviation due to downregulation of antigen-specific delayed-type hypersensitivity and an efferent blockade of the immune response by the cells of the cornea and the aqueous humor.