Use of Sterile Corneal Tissue for Boston Type-I Keratoprosthesis
M. Ali Haider D.O., James V. Aquavella M.D., Garrick Chak M.D.
World Cornea CongressApril 9, 2010
The authors have no financial interest
Purpose
To determine the utility of sterile donor corneal tissue for:
1. Primary keratoprosthesis (KPro) surgery 2. KPro repair
Background
What is sterile donor cornea?
- Has been irradiated- Does not have corneal epithelium and endothelium- Can be stored at room temperature - Can be shipped to distant locations
Ocular surface epithelialization
Purpose of our study included a comparison between ocular surface epithelialization in KPro utilizing sterile cornea versus traditional donor tissue
Materials & Methods- Obtained sterile corneal tissue weeks prior to its use in surgery
- Tissue was transported by mail and stored at room temperature
- 6 patients received Boston type I KPro with sterile corneal tissue
- 2 patients with previously implanted KPro received sterile cornea tissue for KPro repair
- Bandage contact lens utilized in all cases
Sterile Corneal Tissue options:
- 7mm diameter cornea with a 3mm central trephine opening- 8.5mm diameter cornea with a 3mm central trephine opening- Entire cornea with scleral rim
Measurable Outcomes
• Measurable Outcomes:– Wound healing– Epithelialization– Clarity of the cornea disc– Slit lamp exam– Visual acuity– KPro retention
Results
Postoperative comparison:• Similar outcomes in patients who underwent
surgery utilizing sterile corneal tissue v. traditional donor cornea:
- wound healing - clarity of cornea disc - slit lamp exam - visual acuity - retention of KPro - ocular surface epithelialization
• There were no complications postoperatively when using sterile cornea tissue
KPro repair with sterile cornea
A) Pre-operative with history of Peter’s anomaly
B) 8 months s/p primary KPro with extrusion
C) 6 months s/p KPro repair using sterile cornea
Conclusion
Our results show that sterile corneal tissue may successfully be employed for patients undergoing primary keratoprosthesis and for keratoprosthesis revision.
Clarity, stability, and re-epithelialization with KPro utilizing sterile cornea was comparable to KPro utilizing traditional donor cornea.
Sterile cornea can be utilized as a backup for emergencies in keratoprosthesis surgery.
References• Aquavella JV, Qian Y, McCormick GJ, Palakuru JR. Keratoprosthesis:
current techniques. Cornea. 2006 Jul;25(6):656-62.
• Duan D, Klenkler BJ, Sheardown H. Progress in the development of a corneal replacement: keratoprostheses and tissue-engineered corneas. Expert Rev Med Devices. 2006 Jan;3(1):59-72.
• Griffith M, Hakim M, Shimmura S, et al. Artificial human corneas: scaffolds for transplantation and host regeneration. Cornea. 2002 Oct;21(7)S54-61.