Ciliary Body Resection (Cyclectomy and Iridocyclectomy)

• Indications

• Preparation by Ophthalmologist

• Preparation by Ophthalmic Histotechnologist/Cytotechnologist

• Issues for the Pathologist

• More questions?

Indications

• The most common indications for corneal transplantation include pseudophakic or aphakic bullous keratopathy; Fuchs' dystrophy, and keratoconus.
• Other indications include corneal scar, corneal dystrophies, corneal infections, and repeat penetrating keratoplasty for graft failure or rejection.

Preparation by Ophthalmologist

 

• Tissue excised by the surgeon should be kept moist until the donor corneal tissue is sewn in place and the excised tissue can be fixed or divided for fixation and culture (where indicated).
• Formalin fixation (10% neutral buffered formalin) is adequate for most specimens, but keep in mind that formalin is not a universal fixative. Formalin fixation is contraindicated in some conditions including some types of crystalline keratopathy.
• Surgeons are encouraged to make a quick sketch of the cornea indicating any scars or areas of interest that would help the pathologist in examining the tissue.
• If orientation of the specimen is an issue, place a suture through the specimen at one edge and indicate the clock hour of the suture's location on the pathology requisition slip.

Preparation by Ophthalmic Histotechnologist/Cytotechnologist

Issues for the Pathologist

 

• It is often useful to begin the histologic examination of corneal buttons by using the PAS-stained slide to examine Descemet's membrane and the corneal endothelium (it's where most of the action is!).
• Most corneal buttons from patients who have had a previous penetrating keratoplasty represent graft failure rather than immunologically-mediated graft rejection.

 

Pseudophakic bullous keratopathy, PAS stain. No endothelial cells are identified. Pseudophakic and aphakic bullous keratopathy are leading indications for corneal transplantation in the United States.