Sophie J. Bakri, M.D. and Keith H. Baratz, M.D. are ophthalmologists at Mayo Clinic in Rochester, Minnesota. Dr. Bakri, who specializes in retina surgery, and Dr. Baratz, who specializes in cornea surgery, perform a Boston type 1 keratoprosthesis, pars plana vitrectomy with replacement of silicone oil in this procedure.
I want to do is Mark seven for our temporary prosthesis. And then 8.5 for the permanent prosthesis. So I'll do this I'll try to find full thickness with a 7-5. Once with Mark 8.5 is a partial thickness incision along the 8.5 millimeter tree. Find mark. Okay, now we do a 7.25 millimeter reformation within that 8.5. So far we've just removed a seven millimeter button of the host cornea and switching on a seven millimeter temporary prosthesis. So for the prosthesis, I'd like to go from the prosthesis through the host and then back and host through the edge of the prosthesis. Like so Just do four of these Sutras one. Each quadrant is enough to give you a watertight seal. This is the edge of the prosthesis. So this would be about 3.5 injecting balanced salt solution. But it is coming out here, right there is a little hole in the flange and that's a source of leakage. So it seems looking at this retina that there is a lot of fibrosis here. You can see this would be the edge of an old redneck to me that was done. And I think the best case situation here would be to keep this as is and put silicon oil in the eye to prevent even further tie ISIS do is first do an 8.5 millimeter transformation on the donor cornea center that some of the culture medium. So now to cut the donor with 8.5 millimeter tree. Fine on the hand a tree fine system. The next step is to make a three millimeter punch in the center. So there's our donor place the cornea donor on top of that. So this is a titanium back plate, 8.5 millimeters in diameter. Alright, so at this point we're going to do is take off a temporary prosthesis and then remove the peripheral rim of corneal tissue between the 7.25 and 8.5 millimeter. Trevor nations. Yes. Some of the edge of the donor roughly flush with the host. So if I go very deep in the host tissue, then it's going to be under ride Because the host tissues so thick. The challenge here is we've got a very small. I so I didn't want to do a real large definition. If we would have gone 9.5 or so on the host, then we wouldn't have this problem. But because the tree find size is exactly the same size as the back plate and the peripheral tissues so much thicker. Creating a challenge. And how the processes wants to sit in the Alright, so our 16 interrupted nine futures are in Boston K pro looks secure and wound looks secure and clip the future ends. Alright, so we used to replace two of our knots two of our teachers here. So here we see the final picture of how the retina looks. We're gonna now fill the vitreous cavity up with air and we're gonna exchange for oil. So as I inject the silicon oil into the cavity, the air is escaping up the infusion line. And when we do an oil fill, I do want to make sure that it's not artificially filled. In other words that we don't have a big air bubble, but yet the oil is up here. So I actually like to move the eye around to make sure that any air bubbles come up the tube as well. I'm just making sure I get the first suture in here. If it needs a second one, we'll put that in. Remember? This is very friable squarer. So, we're going to use the infusion here. We're going to irrigate everything and pressure that they just don't want the pressure high. All right, are you going
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