SCIENTIFIC REPORT

Microkeratome assisted deep lamellar keratoprosthesis

S Shimmura^1,3, H Miyashita¹, Y Uchino³, T Taguchi², H Kobayashi², J Shimazaki¹, J Tanaka² and K Tsubota^1,3

¹ Department of Ophthalmology, Keio University, Tokyo, Japan
² Biomaterials Center, National Institute for Materials Science, Ibaragi, Japan
³ Department of Ophthalmology, Tokyo Dental College, Chiba, Japan

Correspondence to:
Correspondence to:
Shigeto Shimmura MD
Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; shige{at}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 µm 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 -smooth muscle actin (-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 -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.

Abbreviations: -SMA, -smooth muscle actin; BSA, bovine serum albumin; COL-PVA, collagen I immobilised poly(vinyl alcohol); DLKPro, deep lamellar keratoprosthesis; DM, Descemet’s membrane; DMSO, dimethyl sulfoxide; HE, haematoxylin and eosin; HMDI, hexamethylene dissocyantate; Kpro, keratoprosthesis; LKP, lamellar keratoplasty; LASIK, laser in situ keratomileusis; PBS, phosphate buffered saline; PRK, photorefractive keratectomy; PVA, poly(vinyl alcohol)

Keywords: keratoprosthesis; transplantation; microkeratome; rabbit

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