**7. Postoperative management**

Immediate postoperative treatment focuses on prevention of recurrence of infection and hastening the complete epithelization of the graft.


Box 1. Guidelines for postoperative management of terapeutic keratoplasty

Therapeutic Keratoplasty for Microbial Keratitis 25

This is a generally avoidable complication with a watertight wound. At the end of the surgery is critical that we ensure the integrity of the wound. Shallow or flat anterior chamber if present, should be managed as soon as possible to avoid synechiae formation which may result in irreversible endothelial cell loss and consequently early graft failure. In our center we needed to reform the anterior chamber either with BSS or with viscoelastic

Fig. 14. Flat anterior chamber in this patient with synechiae formation post therapeutic

the hemorrhage persists in the presence of an adequate IOP, then it may need to be

Surgical trauma on an eye with vessels on the surface of the iris or in the cornea can cause hyphema. Every effort should be done to prevent bleeding from the iris surface. Slight bleeding usually stops spontaneously with closure of the eye and return of adequate IOP. If

Fig. 15. Fibrine and hyphema 48 hours post keratoplasty in severe fungal ulcer (*Aspergillus* 

**8.1.2 Shallow or flat anterior chamber** 

substances in 1, 7 % of the cases.

keratoplasty

*flavus)* 

**8.1.3 Hyphema** 

Appropriate antimicrobial therapy must be continued postoperatively until the corneal epithelium has healed

The general guidelines for postoperative management are shown in (Box 1). Therapy may be guided by histopathological and microbiological evaluation of the excised corneal tissue.
