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Histological study of graft failure in AlphaCor transplantation
Shintaro Kanayama1, Shai Garty, Bryan Kim
1Department of Ophthalmology, Minoh City Hospital, 5-7-1 Kayano Mino, Osaka, 562-8562, Japan. shintarokanayama@gmail.com
Abstract:
To report clinical and histopathologic findings in a case of a failed AlphaCor artificial cornea explanted due to corneal stromal melting. We describe the case of a 77-year-old man who received multiple penetrating keratoplasties (PKPs) and subsequent placement of an AlphaCor artificial cornea. Examination showed total corneal infiltration as well as an AlphaCor that was partially dehisced from the host cornea. After explantation, the implant and adjacent host tissue underwent hematoxylin and eosin staining and high-resolution scanning electron microscopy (HR-SEM). Histopathologic analysis of the specimens revealed infiltration of the skirt pores by reactive corneal fibroblasts. Although the AlphaCor implant is an established method of treating multiple failed PKPs, in this case, HR-SEM imaging strongly suggests that the strength of the interface between the implant and corneal tissue is highly dependent on collagen deposition between the pores found in the implant skirt. Collagen deposition then increases the mechanical strength of the cornea-skirt interface.
Insights
A failed AlphaCor artificial cornea explant showed corneal stromal melting due to fibroblast infiltration. Enhanced collagen deposition at the implant-cornea interface may improve mechanical strength and prevent future failures.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Histopathology
Background:
- Artificial cornea implants like AlphaCor are used for patients with multiple failed penetrating keratoplasties (PKPs).
- Understanding the failure mechanisms of artificial cornea implants is crucial for improving patient outcomes.
- Corneal stromal melting is a severe complication that can lead to implant explantation.
Observation:
- A 77-year-old male patient experienced AlphaCor artificial cornea failure due to corneal stromal melting.
- Clinical examination revealed total corneal infiltration and partial dehiscence of the AlphaCor implant.
- Histopathologic analysis utilized hematoxylin and eosin staining and high-resolution scanning electron microscopy (HR-SEM).
Findings:
- HR-SEM imaging demonstrated infiltration of the AlphaCor skirt pores by reactive corneal fibroblasts.
- The study suggests that the interface strength between the implant and corneal tissue is dependent on collagen deposition within the skirt pores.
- Fibroblast infiltration into the pores may compromise the structural integrity of the implant-cornea interface.
Implications:
- This case highlights the importance of the host tissue response and collagen integration for the long-term success of artificial cornea implants.
- Strategies to promote collagen deposition at the implant-cornea interface could potentially enhance mechanical stability and reduce failure rates.
- Further research into biomaterial design and host tissue integration is warranted to improve artificial cornea technology.
