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

Outline

-Background

-Materials & Methods

-Results

-Discussion

-Conclusions

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

Primary KPro with sterile cornea

A) Preoperative B) 1 month s/p primary KPro

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.

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• 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.