Proper planning is the key to successful PKP

Refractive surgeons wishing to achieve successful penetrating keratoplasty need only plan their surgeries more closely.

In a presentation entitled "Treating Intraoperative Penetrating Keratoplasty (PKP) Complications," Mark Mannis, MD, of the United States outlined four elements to a successful PKP surgery at the World Ophthalmology Congress on Monday. The elements are: 1) careful patient selection, 2) careful donor selection, 3) proper pre-operative planning, and 4) have a readiness for the unexpected.

Dr. Mannis pointed out that most PKP complications occur because of either poor patient selection or poor donors. Some patient factors to consider with regard to PKP include age, an underlying disease, body habitus, ocular surface factors, and pre-anesthesia factors.

Proper pre-operative planning includes the proper procedure selection. Is it PKP or is it a combined procedure? Dr. Mannis urges that the physician have the proper tools at their disposal, including an elevating lid speculum, a Fliering Ring, and a Honan balloon. During surgery, physicians should maintain correct donor handling and assure the proper placement of the Fliering Ring because poor placement can cause astigmatism.

Dr. Mannis also suggested that when it comes precautionary measures, surgeons should always try to prevent bleeding. If bleeding does occur, he recommends Thrombin because it works instantly to stop blood flow and begin clotting. It also stabilizes the ocular surface and there are no side effects.