Filatov's 1930's Keratoplasty technique

Vladimir Filatov. Early 20th century. Pioneering corneal transplant surgeon

(From Vladimir Filatov, 1875-1956, Rosenwasser, G.O.D., Rosenwasser, M.  in Mannis, M.J. and Mannis, A.A., eds. Corneal Transplantation: A History in Profiles, J.P. Wayenborgh, Belgium, 1999)

The Whole Globe Exam  After obtaining the donor globes by enucleation the corneal caps are separated from the rest of the globe, and the sclera preserved if desired. The following protocol is an example of one acceptable method for whole globe examination. EBAA Donor Globe In Vitro Exam Protocol F1.200  Slit Lamp Examination  In Vitro Purpose:  To delineate the procedure for slit lamp biomicroscopy of corneal tissue in the laboratory. Materials needed:  Slit lamp biomicroscope  Utility clamp or other appropriate device to hold the ocular tissue  Sterile Cotton-tipped applicators  Sterile ophthalmic irrigating solution  Sterile gloves  Alcohol prep pads  Mask and cap  Rating scale  Forms for documentation Procedure with Rationale in Italics 1.  Allow the eye or cornea to reach normal room temperature. Avoid multiple repeated warming / cooling cycles.  In order to obtain an accurate evaluation of the corneal endothelium. 2.  Don mask, cap, sterile gloves, protective clothing and protective eye wear when examining the whole eye. 3.  Remove eye jar lid and place it so that the inside of the cap is facing up in a clean area such as the hood or biosafety cabinet. Prevents contamination of ocular tissue when lid is returned to eye jar. 4.  Remove any excess liquid from eye jar. Minimizes leakage on slit lamp biomicroscope and work area while evaluating. 5.  Insert eye jar, vial, or corneal storage viewing chamber into utility clamp or other appropriate device. This secures the ocular tissue while performing the evaluation. 6.  Using sterile cotton-tipped applicators, gently manipulate eye cage, if one is used, to bring cornea within viewing range of slit lamp.  Sterile forceps or hemostats can also be used instead of cotton-tipped applicators. The contents of the eye jar are assumed to be sterile. Using sterile instruments during examination will ensure sterility is maintained.  7.  Moisten the eye with sterile ophthalmic irrigating solution as necessary. This prevents excessive drying and possible contamination of corneal epithelium. 8.  Perform a low power examination first at 10 X magnification when evaluating an eye/cornea for the first time. This gives orientation and location and entire view of cornea and eye simultaneously. 9.  Diffuse illumination of the cornea is done with a wide slit of light directed on the cornea at approximately a 15° to 20° angle of incidence and then moved to scan the entire cornea. To properly evaluate and see endothelium, the angles indicated must be observed. 10. Next perform direct focal illumination using high power examination to perform an in-depth evaluation of the cornea.  Adjust the width of the beam; a narrower slit beam will allow more in-depth examination and detail.  With specular reflection you can observe the endothelium, cell morphology, dark areas, and areas where the cells are  absent.  Corneal endothelium is a good indicator of the quality of ocular tissue.  Anything other than normal hexagonal shaped cells should be noted and documented. 11. Make notations on the donor information form regarding the evaluation and what was observed during initial evaluation. After preserving ocular tissue, the initial evaluation may differ from final evaluation. 12. Record and diagram any abnormalities present regarding epithelium, stroma, and endothelium.  Bowman's layer and Descemet's membrane are not necessarily visible with slit lamp examination.  It is important to record quality of ocular tissue when determining whether it is suitable for surgery. 13. Evaluate and record the minimum information below: A. Corneal clarity, noting any scars, edema, or significant arcus that would reduce the optical clear zone needed by the transplanting surgeon B. Folds or striae, noting severity, i.e., 0, 1+, 2+ C. Presence or absence of epithelial defects, and amount D. Presence or absence of guttate change and amount E. Presence or absence of stretch striae F.  Presence or absence of polymegathism or pleomorphism and amount G.  Evidence of any technical problems in removal H. Presence of any infiltrates or foreign bodies 14.  Assign a rating to the ocular tissue, such as excellent, very good, etc. according to your eye bank's policy and rating scale. The classification used in the rating scale should be defined in the eye bank's procedure manual.  Slit lamp evaluation of the cornea following removal from the eye adn placement into tissue culture medium is mandatory and must be performed and recorded. See EBAA Medical Standards section F1.200.

    

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