Donor cross-linking for keratoplasty: a laboratory evaluation

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomaterials Science

Background:

• Penetrating keratoplasty (PKP) is a common corneal transplantation procedure.
• Astigmatism and higher-order aberrations are significant challenges impacting visual outcomes after PKP.
• Novel techniques are needed to improve the refractive predictability and success of PKP.

Purpose of the Study:

• To compare the topographic and refractive outcomes of conventional PKP with a novel technique.
• To evaluate the efficacy of pre-keratoplasty donor cornea cross-linking in reducing induced astigmatism and aberrations.

Main Methods:

• A porcine whole globe model was used for penetrating keratoplasty with continuous running sutures.
• Sixty eyes were divided into two groups: conventional PKP and PKP with pre-cross-linked donor corneas (riboflavin/UVA).
• Topographic and corneal wavefront measurements were performed post-surgery.

Main Results:

• The cross-linked donor group showed significantly lower mean keratometric astigmatism (3.67D vs. 8.43D) and wavefront astigmatism (4.71D vs. 8.29D) compared to the conventional group (p < 0.005).
• Mean RMS higher-order aberrations were significantly reduced in the cross-linked donor group (1.79 µm vs. 3.05 µm, P = 0.02).
• Qualitative analysis indicated less tissue distortion at the graft-host junction in the cross-linked group.

Conclusions:

• Cross-linking donor corneas before penetrating keratoplasty effectively reduces intraoperative induced astigmatism and aberrations.
• This modification of keratoplasty surgery holds potential for improving visual quality after corneal transplantation.
• Further clinical studies are warranted to validate these findings and assess long-term implications.