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Published on: July 6, 2015
Microkeratome assisted deep lamellar keratoprosthesis
S Shimmura1, H Miyashita, Y Uchino
1Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. shige@sc.itc.keio.ac.jp
Aims:
To establish a keratoprosthesis (Kpro) surgical technique that maintains an intact superficial corneal layer.
Methods:
A manual microkeratome (Moria LSK-1) was used to create a 130 mum flap of approximately 10 mm diameter in the right eye of Japanese white rabbits. The stoma beneath the flap area was dissected before the removal of a 5.0 mm stromal disc. A 5.0 mm collagen I immobilised poly(vinyl alcohol) (COL-PVA) disc was placed on the exposed posterior stroma close to Descemet's membrane. The flap was repositioned and fixed using 10-0 nylon sutures, which were removed 2 days following surgery. The corneas were followed clinically by slit lamp microscopy and photographs. Rabbits were sacrificed after 6 months, and the transplanted corneas were examined histologically by haematoxylin and eosin staining and immunohistochemistry against vimentin and alpha-smooth muscle actin (alpha-SMA).
Results:
The transplanted COL-PVA discs remained transparent throughout the study, with no complications related to the flap or overlying epithelium. The interface between COL-PVA and Descemet's membrane remained clear without signs of opacification caused by scarring or cellular deposition. Pathology revealed the intact COL-PVA polymer in the posterior stroma, with minimal cellular infiltration along the anterior and posterior interfaces. Immunohistology shows vimentin and alpha-SMA staining at levels comparable to lamellar keratoplasty control.
Conclusions:
Microkeratome assisted deep lamellar keratoprosthesis may be a safe technique for the transplantation of artificial hydrogels for therapeutic purposes.
Insights
A novel keratoprosthesis technique using a microkeratome preserved the superficial corneal layer. This deep lamellar keratoprosthesis with artificial hydrogel discs showed promising results in rabbit models.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Surgical Innovation
Background:
- Corneal transplantation is crucial for vision restoration.
- Existing keratoprosthesis techniques can have limitations.
- Maintaining the superficial corneal layer is a surgical goal.
Purpose of the Study:
- To develop a keratoprosthesis (Kpro) surgical technique that preserves the superficial corneal layer.
- To evaluate the safety and efficacy of a novel deep lamellar keratoprosthesis using artificial hydrogel implants.
Main Methods:
- A manual microkeratome created a corneal flap in rabbit eyes.
- A collagen I immobilized poly(vinyl alcohol) (COL-PVA) disc was implanted.
- Corneal healing and implant integration were assessed histologically and clinically for 6 months.
Main Results:
- The COL-PVA discs remained transparent without flap or epithelial complications.
- No opacification or significant cellular deposition occurred at the implant interface.
- Histology showed minimal cellular infiltration and comparable vimentin/alpha-SMA staining to controls.
Conclusions:
- Microkeratome-assisted deep lamellar keratoprosthesis is a potentially safe technique.
- This method facilitates the transplantation of artificial hydrogels for therapeutic purposes.
- The technique shows promise for future corneal reconstruction strategies.
