What pre-operative assessments are necessary for patients undergoing keratoplasty?

Pre-operative assessments for patients undergoing keratoplasty should include detailed corneal evaluation such as keratometry to measure corneal curvature and corneal topography for irregular, abnormally flat or steep corneas, or significant astigmatism, especially if accurate keratometry is not possible. These assessments help in planning the surgery and selecting appropriate intraocular lenses if needed. Additionally, biometry techniques including optical or ultrasound biometry to measure axial length of the eye are important to guide surgical planning. A thorough review of the patient’s medical notes and confirmation of identity, along with a risk stratification to identify patients at increased risk of complications, should be performed. Discussions with the patient about the risks, benefits, and expected outcomes of surgery, including refractive implications, are essential. A surgical safety checklist adapted from the WHO checklist should be used to confirm patient identity, surgical site, and availability of correct surgical materials. Anaesthetic considerations and planning should also be part of the pre-operative assessment. These steps ensure patient safety and optimize surgical outcomes for keratoplasty ¹.