Visual rehabilitation - glasses or contact lenses fitting (if required)
17
Final examination
Patient consultation and Exam
Begin by conducting a comprehensive consultation and examination with the patient. This will help determine the appropriate course of action for the keratoplasty procedure. Gather necessary medical history and perform necessary tests to assess the patient's condition. Ensure the patient is informed about the procedure, its potential impact, and any potential risks or complications.
1
Visual acuity test
2
Slit-lamp examination
3
Corneal topography
4
Optical coherence tomography
5
Pachymetry
1
Obtained
2
Not obtained
3
Already obtained
Determination of type of keratoplasty needed
Based on the patient's condition and examination results, determine the specific type of keratoplasty that is required. This could include penetrating keratoplasty, anterior lamellar keratoplasty, or endothelial keratoplasty. Consider the advantages and disadvantages of each option in order to make an informed decision. Discuss the options with the patient and obtain their agreement on the chosen procedure.
1
Penetrating keratoplasty
2
Anterior lamellar keratoplasty
3
Endothelial keratoplasty
Acquisition of donor cornea
Once the type of keratoplasty has been determined, proceed with acquiring a suitable donor cornea for the procedure. Follow established protocols for cornea retrieval and ensure proper storage and transportation to maintain its viability. Collaborate with the relevant tissue banks or organizations to obtain a suitable donor cornea.
Approve: Donor cornea suitability
Verify the suitability of the acquired donor cornea for the intended keratoplasty procedure. Assess factors such as tissue quality, corneal thickness, endothelial cell count, and donor-recipient compatibility. Discuss the findings with the surgical team and obtain their approval for proceeding with the transplantation. Communicate any concerns or deviations from the expected criteria.
1
Tissue quality
2
Corneal thickness
3
Endothelial cell count
4
Donor-recipient compatibility
Patient preparation - Anesthesia
Prepare the patient for the keratoplasty procedure by administering the appropriate anesthesia. Consider factors such as the patient's medical history, allergies, and potential adverse reactions. Collaborate with the anesthesiologist to ensure the patient's comfort and safety during the surgery.
1
Local anesthesia
2
General anesthesia
Removal of diseased or injured corneal tissue
Perform the surgical removal of the diseased or injured corneal tissue from the patient. Follow established surgical protocols and use the appropriate surgical instruments. Take necessary precautions to minimize any damage to surrounding tissues and structures. Document any relevant findings or observations during the procedure.
Suturing of donor cornea
Suture the acquired donor cornea onto the patient's eye using the appropriate sutures and techniques. Ensure proper alignment and tension to promote optimal healing and minimize the risk of complications. Collaborate with the surgical team to ensure a successful corneal grafting procedure. Document the suturing and any relevant notes or details.
Post-operative antibiotic administration
Administer post-operative antibiotics to the patient to prevent infection and promote healing. Follow the prescribed dosage and duration based on established guidelines. Educate the patient on the importance of compliance and any potential side effects or precautions. Monitor the patient for any adverse reactions or complications.
Patient monitoring & recovery
Monitor the patient closely during the recovery period to ensure proper healing and identify any potential complications. Schedule regular follow-up visits and provide necessary support and guidance. Collaborate with the patient to address any concerns or issues that may arise during the recovery process.
Schedule follow up appointments
Schedule follow-up appointments with the patient to assess their progress and address any concerns or issues. Establish a suitable timeframe for these appointments based on the patient's condition and the specific requirements of the keratoplasty procedure. Ensure proper coordination with the patient and any other healthcare professionals involved.
First follow up visit
Conduct the first follow-up visit with the patient to evaluate their progress and address any post-operative concerns. Perform necessary tests and assessments to assess the success of the keratoplasty procedure. Communicate the findings to the patient and provide appropriate recommendations or interventions if needed.
1
Visual acuity test
2
Slit-lamp examination
3
Intraocular pressure measurement
4
Corneal topography
5
Endothelial cell count
Approval: Ophthalmologist for healing process
Post-operative medication management
Manage the post-operative medication regimen for the patient to support their recovery and optimize the outcome of the keratoplasty procedure. Ensure compliance with the prescribed medications and educate the patient on the proper administration and potential side effects. Monitor the patient's response to the medications and address any concerns or issues that may arise.
1
Corticosteroid eye drops
2
Antibiotic eye drops
3
Anti-inflammatory medications
4
Pain relievers
5
Eye lubricants
Periodic eye exams
Schedule periodic eye exams for the patient to monitor the long-term success of the keratoplasty procedure and detect any potential complications or issues. Follow established guidelines for the frequency and scope of these exams. Collaborate with the patient to ensure their compliance and address any concerns or changes in their condition.
1
Every 3 months
2
Every 6 months
3
Every 12 months
4
As needed
Suturing removal (if required)
If necessary, remove the sutures from the corneal graft site to facilitate healing and optimize the patient's visual outcome. Follow established protocols for suture removal and use appropriate techniques and instruments. Document the procedure and any relevant observations or instructions for the patient.
Visual rehabilitation - glasses or contact lenses fitting (if required)
If visual rehabilitation is necessary following the keratoplasty procedure, facilitate the fitting of glasses or contact lenses for the patient. Collaborate with optometrists or ophthalmologists to determine the most appropriate options based on the patient's visual needs and the outcome of the keratoplasty. Communicate the recommendations to the patient and provide any necessary guidance or support.
1
Glasses
2
Soft contact lenses
3
Rigid gas permeable contact lenses
4
Hybrid contact lenses
5
Scleral contact lenses
Final examination
Conduct a final examination of the patient to evaluate the overall success of the keratoplasty procedure and assess their visual outcome. Perform necessary tests and assessments to confirm the stability and effectiveness of the corneal graft. Communicate the findings to the patient and provide appropriate recommendations for long-term care and maintenance.
