Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaImprovement of the water tightness of a monoblockeratoprosthesis with the use of a surgical bio-glue. Preliminaryresults in dogsPierre F. Isard 1 , Marielle Mentek 2 , Thomas Dulaurent 1 . 1 CentreHospitalier Vétérinaire Saint-Martin, Saint-Martin Bellevue, France;2 INSERM U1042, Grenoble, France.Purpose: The mid- and long-term water tightness is a key point inthe keratoprosthesis (KP) implantation procedure. Majorcomplications such as athalamia and endophtalmitis may be linked toincomplete water tightness. The use of a surgical bio-glue may be asatisfactory solution to prevent the risk of aqueous humor leakage.Methods: Patients: 5 dogs were presented for vision loss of cornealorigin, secondary to an immune-mediated chronic superficialkeratitis.Keratoprosthesis: KPro-LID® is a full thickness monobloc PMMAKP, with 4 retrocorneal fixation sites and without colonisable skirt.Surgical bio-glue: GRF® was originally manufactured for vascularsurgery. It is composed of gelatin/resorcin (adhesive property) andformaldehyde/glutaraldehyde (hardening property).Surgical procedure: aAfter 6 months, no water-tightness defect wasobserved and no abnormal tissue reaction was identified, secondaryto the use of GRF glue. 0.2 mm depth x 5.5 mm diameter superficialkeratectomy was performed in the central cornea. Around thekeratectomy site and at the same depth, the superficial cornea wasundermined over 360°. The dissected cornea was cut over 300°, 2mm in front of the limbus and parallel to it. The rim was reflectedand a complete penetrating, 5.5 mm diameter central keratectomywas performed. After filling the anterior chamber with viscomaterial,the keratectomy was enlarged with a 3 mm full-thicknessradial incision. The KP was implanted and anchored to the cornea bypassing 4 U-shaped sutures through the retrocorneal fixation sites.The corneal radial incision was sutured and the GRF glue wasapplied over the uncovered corneal surface, up to the edge of the KP.The superficial rim was repositioned and the circular peripheralincision was sutured. The dogs were re-evaluated at 8 days, 15 daysand then monthly for 6 months.Results: After 6 months, no water-tightness defect was observed andno abnormal tissue reaction was identified, secondary to the use ofGRF glue.Conclusions: The GRF glue improved the water-tightness of theKPro-LID in dogs. The ease of use and safety of this bio-glue make itan important step of the KP implantation surgical procedure.Implanted KP after retrocorneal and GRF glue (arrow) fixation.GRF glue addition with a needle (25G) after retrocorneal fixaton.Commercial Relationships: Pierre F. Isard, None; MarielleMentek, None; Thomas Dulaurent, NoneProgram Number: 3472 Poster Board Number: D0099Presentation Time: 11:00 AM - 12:45 PMAgreement among Transpalpebral, Transcleral and TactileIntraocular Pressure Measurements in Eyes with Type 1 BostonKeratoprosthesisJessica L. Liu, Thasarat S. Vajaranant, Maria S. Cortina, Jacob T.Wilensky. Glaucoma, University of Illinois at Chicago, Chicago, IL.Purpose: The use of keratoprostheses (KPro) to restore vision in eyeswith corneal opacities has become increasingly popular in the lastfive years. Intraocular pressure (IOP) is a cardinal measurementemployed in glaucoma management. This presents a major problemsince glaucoma remains a major visual limiting factor in eyes withKPro and most forms of tonometry require an intact cornea. Thepurpose of this study is to determine if transpalpebral IOPmeasurement can be an alternative method of measuring IOP andyield valuable data in eyes with KPro.Methods: We retrospectively reviewed IOP measurements inpatients who had received Type 1 Boston KPro, and their IOP wereestimated by three different methods during routine visits to theircorneal surgeon. The surgeon estimated the IOP range tactilely bypalpation of the globe. A pneumatonometer (Model 30 Classic;Mentor, BioRad, Santa Ana, California, USA) was used to measureIOP by placing the tonometer tip on the sclera peripherally to thecontact lens in the inferotemporal quadrant. The Diaton tonometer(BiCOM, Inc., Long Beach, NY, USA) was used to obtain valuesthrough the upper lid in accordance with the instructions by themanufacturer. An average of two Diaton IOP measurements was usedin the analysis. Since the tactile IOP were recorded as a range ratherthan a definite number, we computed the percent agreement, thepercentage of eyes in which pneumatometer or Diaton IOPs werewithin 2 mmHg of the tactile IOP range. Two-tailed t-test was used tocompare the mean of pneumatonometer and Diaton IOPmeasurements.Results: The analysis included 23 eyes of 20 patients. Thepercentage agreement was 85% between tactile range andpnematonometer IOPs, and 95% between tactile range and DiatonIOPs. Pneumatonometer consistently yielded higher IOP values,compared to Diaton (p = 0.04). The overall IOP mean ± SD was 17.2± 6 mmHg for pneumatonometer and 13.8 ± 5 mmHg for Diatontonometer.Conclusions: The presence of KPro did not appear to interfere withIOP with Diaton tonometer, and Diaton tonometer yielded IOPreadings that were similar to those obtained by palpation. Scleralpneumotonometry yielded values that were consistently higher thantactile estimates and Diaton IOP. In addition to routine IOP estimatesby palpation, transcleral and transpalpebral IOP measurements can beconsidered to monitor patients with KPro.©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.