Management
10.7 Femtosecond Incisions for Correction of Post-
Additionally, as shown in Fig. 10.5 , the tissue alignment in FLEK is excellent – translating into a smoother anterior curvature, allowing for lower levels of regular astigmatism. The combination of a stronger wound and lower levels of astigmatism allows for suture removal at an earlier stage (Steinert et al. 2007 ; Farid et al. 2007 , 2009 ; Buratto and Böhm 2007 ; Chamberlain et al. 2011 ) .
10.7 Femtosecond Incisions
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Corneal surgeons and their local eye banks have a symbiotic relationship (Lee et al. 2013 ).
Corneal surgeons cannot operate without their local eye banks, and eye banks would not exist without corneal surgeons. They both have the same purpose: to provide safe and effective tissue for patients in order to restore vision and elimi- nate corneal blindness. Over the past two decades, eye banks in the United States have been able to meet the needs of both surgeons and their patients allowing for scheduled surgery. As cornea trans- plant surgery has evolved, surgeons have come to expect the availability of corneal tissue when their patient needs a transplant. Transplanting only specifi c layers of the cornea requires sur- geons to either prepare their own tissue in the operating room, risking tissue wastage/cancelled surgery, or order precut tissue from the eye bank.
The availability of corneal tissue, particularly tissue that is prepared according to surgeon instructions, has created the perception that cor-
neal tissue is a commodity. However, the fact that corneal tissue availability depends on the generosity of a person or family places it in the category of a precious gift, not a manufactured item, like the intraocular lens that is ordered off the shelf. In fact, with the evolution of corneal surgery to partial- thickness corneal transplanta- tion, corneal surgery now begins in the eye bank with pre-cutting or preparation of the donor cornea for a specifi c procedure. In Descemet’s stripping automated endothelial keratoplasty (DSAEK) or Descemet’s membrane automated endothelial keratoplasty (DMAEK), the eye bank technician not only harvests the tissue, he or she cuts the tissue to a predetermined thickness, and may even load the tissue into a delivery system prior to shipping. As a result of these revolution- ary changes to cornea surgery and tissue prepara- tion in the eye bank, surgeon involvement, guidance, and partnership with the eye bank are more important than ever to achieve successful sight restoration for patients.
Physicians in the United States began per- forming corneal transplants in the 1930s, 25 years after Viennese ophthalmologist Dr. Eduard Zirm performed the fi rst corneal transplant. In 1905, Dr Zirm saw a day laborer from a small town in the Czech Republic who had been blinded in both eyes a year earlier while slaking lime.
Around the same time, an 11-year-old boy was brought to Zirm’s clinic due to an accident that embedded metal in one eye. When attempts to save the boy’s eye were unsuccessful, Zirm
M. S. Macsai , MD (*) Department of Ophthalmology , University of Chicago Pritzker School of Medicine , Glenview , IL , USA e-mail: [email protected] A. Nariani , MD, MPH
Department of Ophthalmology ,
University of Chicago , Chicago , IL , USA C. Reed , BSN, MA, RN, PhD
Department of Ophthalmology and Visual Sciences , Iowa Lions Eye Bank, Carver College of Medicine, University of Iowa , Coralville , IA , USA