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Microkeratome assisted deep lamellar keratoprosthesis
  1. S Shimmura1,3,
  2. H Miyashita1,
  3. Y Uchino3,
  4. T Taguchi2,
  5. H Kobayashi2,
  6. J Shimazaki1,
  7. J Tanaka2,
  8. K Tsubota1,3
  1. 1Department of Ophthalmology, Keio University, Tokyo, Japan
  2. 2Biomaterials Center, National Institute for Materials Science, Ibaragi, Japan
  3. 3Department of Ophthalmology, Tokyo Dental College, Chiba, Japan
  1. 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

Abstract

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 α-smooth muscle actin (α-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 α-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.

  • α-SMA, α-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)
  • keratoprosthesis
  • transplantation
  • microkeratome
  • rabbit
  • α-SMA, α-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)
  • keratoprosthesis
  • transplantation
  • microkeratome
  • rabbit

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Footnotes

  • This study was supported by The Advanced and Innovational Research Program in Life Sciences from the Japanese Ministry of Education, Culture, Sports, Science and Technology.

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