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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.
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaCommercial Relationships: Jessica L. Liu, None; Thasarat S.Vajaranant, None; Maria S. Cortina, None; Jacob T. Wilensky,NoneSupport: Carson Gabriel Fund, Research to Prevent BlindnessProgram Number: 3473 Poster Board Number: D0100Presentation Time: 11:00 AM - 12:45 PMRetinal Detachments in Eyes After Boston Keratoprosthesis Type1Sachin Jain, Clement C. Chow, Jennifer I. Lim, Lawrence J. Ulanski,Jose De la Cruz, Maria S. Cortina, Felix Y. Chau. Illinois Eye andEar Infirmary. UIC Department of Ophthalmology and VisualSciences, University of Illinois, Chicago, IL.Purpose: To report the frequency, timing, visual significance,contributing factors, and management of retinal detachment (RD)after successful Boston Keratoprosthesis Type I (KPro) implantation.Methods: A retrospective chart review was conducted of consecutiveKPro implantations at a single institution over a 5 year period.Preoperative and postoperative best-corrected visual acuity (BCVA),ocular co-morbidities, anatomic outcomes, surgical interventions, andcomplications were analyzed.Results: One hundred and three KPros were implanted into 95 eyesof 94 patients over a 5 year period. Fourteen of the 95 eyes (14.7%)developed RDs during a median follow-up of 27.5 months (range 12-58). Pre-KPro diagnoses included HSV keratitis, chemical burn,aniridia, Peters anomaly, Fuchs’ dystrophy, congenital glaucoma,end-stage glaucoma and limbal stem cell deficiency. Ten of 14 eyeshad concomitant surgery, including intraocular lens removal (6), parsplana vitrectomy (PPVx, 5), silicone oil fill (2 for hypotony), Ahmedtube placement (2), pupilloplasty (1) and tarsorrhaphy(1). Themedian time from KPro placement to occurrence of RD was 9months (range 0.5-40 months). Thirteen of 14 (92.9%) eyesunderwent PPVx; only 3 eyes required KPro removal during RDrepair. BCVA prior to KPro surgery was 1.91±0.28 (logarithm ofminimum angle of resolution ± standard deviation). BCVA improvedafter KPro to 1.23±0.58 (p 20/400 at final follow up.Conclusions: RD is a significant complication after KPro surgeryoccurring in 14.7% of 95 eyes. The visual acuity gain after KProsurgery is lost when a retinal detachment occurs, despite goodanatomic outcomes in a majority of eyes (77%) after RD repair.Various ocular coexisting co-morbidities and post-KProcomplications contributed to RDs and decreased visual acuity.Commercial Relationships: Sachin Jain, None; Clement C. Chow,None; Jennifer I. Lim, QLT (F), Genentech (R), Regeneron (R);Lawrence J. Ulanski, Allergan (C); Jose De la Cruz, alcon (C),amo (C); Maria S. Cortina, None; Felix Y. Chau, NoneProgram Number: 3474 Poster Board Number: D0101Presentation Time: 11:00 AM - 12:45 PMImplantation of Biosynthetic Collagen III Corneal Implants invivo in Rabbit Eyes: Surgical Technique and ClinicalPerformanceKarin Kobuch 1 , Raphael T. Neuhann 1 , Kerstin Wand 1 , JohannesJunger 3 , Michael Baumann 3 , Roland Ritter 4 , Mohammad M. Islam 2 ,May Griffith 2 , Chris Lohmann 1 . 1 Ophthalmology, TechnischeUniversität Muenchen, Klinikum rechts der Isar, Munich, Germany;2 Regenerative Medicine, University of Linkoeping, Linkoeping,Sweden; 3 MLase, Munich, Germany; 4 Technolas PV, Munich,Germany.Purpose: To assess laser assisted implantation , sutureless fixation byUV crosslinking and clinical performance of biosynthetic collagen IIIimplants in vivo in rabbit eyes after deep anterior lamellarkeratoplasty (DALK).Methods: Corneal implants from recombinant human collagen III(RHC III or RHC/MPC, 300µm thickness, diameter 6mm) wereplaced on the anterior cornea of rabbit eyes (n=12) after performingDALK with either femtosecond (Victus, Technolas PV Munich,Germany) or excimer laser (MLase Germering, Germany). Implantswere prepared in a corresponding design. After application ofRiboflavin 0.1% for 5 minutes UV-crosslinking was performedaccording to a rapid procedure (18mW/cm2 for 5 minutes).Thereafter a soft bandage contact lens was placed and a tarsoraphywas performed. Postoperatively the rabbits were observed over twoor six weeks by OCT and slitlamp biomicroscopy. Finally the eyeswere examined histologically (HE-stained/ picrosirius stainedsections, electronmicroscopy).Results: Femtosecond laser assisted surgery enabled a 3D cut designfor fixation of the implant. Both laser cuts showed excellent surfaceproperties within the corneal bed and implant. Certain types ofimplants showed minor shrinkage after crosslinking, resulting inperipheral missmatch and reduced adhesion. Good corneal adhesionand fixation of the implant could be achieved in areas, where implantand corneal bed were in close contact intraoperatively and aftercrosslinking, demonstrated by OCT and histology. Loss of implantduring follow up occured in 4 cases due to intra- and postoperativecomplications (laser n=2, opening of tarsoraphy n=2). Cornealneovascularisation was observed around the implant in 3 cases, butnever within the implant. Histology showed good integration of theimplant, reepithelisation and repopularisation with keratocytes.Conclusions: Laser assisted surgery and sutureless fixation by UVcrosslinking show an excellent potential to optimize the surgicalprocedure and minimize complications for implantation of collagenIII biosynthetic corneal implants. The procedure may be morecomplicated in rabbit eyes due to anatomical differences like reducedcorneal thickness and different corneal curvature. The parameters forlaser application will have to be further adapted to guarantee exactfitting and contact of implant and recipient cornea.Commercial Relationships: Karin Kobuch, None; Raphael T.Neuhann, None; Kerstin Wand, None; Johannes Junger, MLaseAG (E); Michael Baumann, None; Roland Ritter, TechnolasPerfect Vision (E); Mohammad M. Islam, None; May Griffith,Univ. of Ottawa - OHRI (P); Chris Lohmann, NoneSupport: EURO Nanomed I-CareProgram Number: 3475 Poster Board Number: D0102Presentation Time: 11:00 AM - 12:45 PMThe effect of the presence of preoperative silicone oil, absence ofprior corneal surgery, and postoperative scleral contact lens useon Boston keratoprosthesis outcomesKareem Moussa 1 , John Petrowski 1 , Natalie A. Afshari 2 . 1 Duke EyeCenter, Duke University, Durham, NC; 2 Shiley Eye Center,University of California, San Diego, La Jolla, CA.Purpose: To report outcomes of the Boston keratoprosthesis in eyeswith a preoperative history of silicone oil, eyes with no prior cornealsurgery, as well as eyes that received a scleral contact lens©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.
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