Cornea - ARVO

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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneacompared to the FHC across the entire range of the visible lightspectrum even though there was no statistical significance. In thecompressive modulus test, very similar values of young’s moduluswere found between the AGC (25.1 ± 5.8 kPa) and the HFC (24.4 ±6.4 kPa). However, in the DSC analysis, the transitional temperature(Tm), which shows matrix organization, of the AGC wassignificantly lower (61.7 ± 1.1C) than that of the HFC (65.7 ± 1.8 C).The DNA content was significantly decreased in the AGC (1.05 ±0.22 µg / mg), when compared to the HFC (1.90 ± 0.11 µg /mg). Inthe cell migration test, more keratocytes were able to migrate throughthe AGC (317± 38.7/mm2) than through the HFC (176.4±48.2/mm2).Conclusions: In this study, we found the AGC is similar to the HFCwith respect to mechanical properties and transparency. In addition,the AGCs allow for more keratocyte migration and include less DNAcontent than HFCs, properties that are potentially beneficial incorneal substitutes. The gamma-irradiation reduces the density ofcollagen fibers and changes the thermal properties of melting.However, the effects of gamma irradiation are not great enough toalter the mechanical properties of corneal ECM. This promisingcorneal substitute could be used in various applications of ophthalmicpractice including corneal transplantation, which may not need viableendothelial cells, as well as in glaucoma patch grafting.Commercial Relationships: Jemin J. Chae, None; Joshep S. Choi,None; Walter Stark, VueCare (C); Jennifer Elisseeff, CollagenVitrigel (P)Support: Frederick N. Griffith Foundation for the Advancement ofTransplantationProgram Number: 5258 Poster Board Number: C0177Presentation Time: 2:45 PM - 4:30 PMStructural changes in the anterior corneal stroma of bullouskeratopathy patients after endothelial keratoplastyNaoyuki Morishige, Yukiko Morita, Naoyuki Yamada, Koh-heiSonoda. Dept of Ophthalmology, Yamaguchi Univ Grad Sch of Med,Ube, Japan.Purpose: We have previously described the presence of subepithelialfibrosis or transdifferentiation of keratocytes into fibroblasts ormyofibroblasts in the cornea of individuals with bullous keratopathy.We have now examined the anterior corneal stroma for structuralchanges in bullous keratopathy patients after endothelial keratoplasty.Methods: Twenty-one individuals who underwent unilateralendothelial keratoplasty (DSAEK) at Yamaguchi University Hospitalbetween November 2007 and July 2012 were enrolled to this clinicalstudy. The subjects were divided into two groups on the basis ofwhether the preoperative duration of stromal edema was less than 12months (group A: three men and seven women, with a mean age of74.6 years) or at least 12 months (group B: five men and six women,with a mean age of 77.9 years). The structure of the anterior stromawas examined with an in vivo laser confocal microscope (HeidelbergRetina Tomography II-Rostock Corneal Module, HeidelbergEngineering) at various times after surgery.Results: In vivo confocal microscopy revealed anterior stromalscattering (ASS), subepithelial fibrosis, or fibroblasticmyofibroblastictransdifferentiation of keratocytes in the studysubjects. Subepithelial fibrosis was detected in 3 of the 10 cases(30.0%) and 10 of the 11 cases (90.9%) in groups A and B,respectively, before surgery, in 2 (22.2%) and 8 (80.0%) cases,respectively, at 3 months, and in 1 (11.1%) and 5 (55.6%) cases,respectively, at 6 months. Fibroblastic-myofibroblastictransdifferentiation was detected in 1 (10.0%) and 8 (72.7%) cases ingroups A and B, respectively, before surgery, in 0 and 3 (30.0%)cases, respectively, at 3 months, and in 0 and 1 (11.1%) case,respectively, at 6 months. ASS was detected in 10 (100%) and 11(91.6%) cases in groups A and B, respectively, before surgery, in 3(33.3%) and 6 (60.0%) cases, respectively, at 3 months and in 1(11.1%) and 6 (66.7%) cases, respectively, at 6 months.Conclusions: Changes in anterior stromal structure similar to thoseapparent in bullous keratopathy patients before surgery were detectedby in vivo confocal microscopy in such patients after DSAEK.Subepithelial fibrosis and ASS persisted for more than 6 months in asubstantial proportion of individuals with a preoperative duration ofstromal edema of less than 12 months.Commercial Relationships: Naoyuki Morishige, None; YukikoMorita, None; Naoyuki Yamada, None; Koh-hei Sonoda, None477 Corneal Cross-linking and KeratoconusWednesday, May 08, 2013 2:45 PM-4:30 PMExhibit Hall Poster SessionProgram #/Board # Range: 5259-5305/C0178-C0224Organizing Section: CorneaProgram Number: 5259 Poster Board Number: C0178Presentation Time: 2:45 PM - 4:30 PMMDV1224 A NEW RIBOFLAVIN FORMULATION FORTRANS-EPITHELIAL CROSS-LINKINGSergio Mangiafico, Danilo Aleo. R&D, Medivis, Catania, Italy.Purpose: The most common procedure for corneal cross-linkingrequires the use of an aqueous solution of Riboflavin-5-phosphate(RFP) instilled in denuded cornea. The aim of our study was thedevelopment of an aqueous new ophthalmic formulation based on anew Riboflavin complex (MDV1224) able to ensure the cornealtrans-epithelial penetration of the active ingredient that would ensurea correct corneal cross-linking.Methods: Trans-corneal permeability of Riboflavin in MDV1224was evaluated by using the Franz diffusion cells (excised porcinecornea) at 37°C, for 360 minutes compared to RFP. The donorchamber contained the MDV1224 or RFP. The receiver chambercontained an isotonic phosphate buffer saline solution (pH 7.4).Samples were collected from the receiver chamber every 60 min andquantitatively analyzed by high performance liquid chromatography(HPLC). The permeation parameters (e.g.: the trans-cornealpermeability, cm/sec) were calculated by plotting the amounts(µg/cm2) of Riboflavin in MDV1224 or RFP permeated through theporcine corneal cells over time (minutes). Riboflavin stability in theMDV1224 was also monitored for six months in dark conditions asrequested by the ICH recommendation and compared to RFP.Results: Trans-corneal permeability of MDV1224 (45.7x10-6cm/sec)was almost tenfold greater compared to that of RFP (4.8x10-6cm/sec). After six months, stability data at 40°C and 25°C showedhigh degradation values for both Riboflavin in MDV1224 and RFPformulations, while at 2-8°C Riboflavin in MDV1224 and RFPshowed only 3% of degradation.Conclusions: The new Riboflavin complex in the MDV1224formulation was able to increase the porcine corneal penetration by852% vs the commercial RFP. In vivo studies are needed to confirmthat the higher delivery of MDV1224 Riboflavin vs RFP is able toguarantee a correct corneal cross-linking after instillation of theMDV1224 in the intact human cornea.Commercial Relationships: Sergio Mangiafico, Medivis (E);Danilo Aleo, Medivis (E)Program Number: 5260 Poster Board Number: C0179Presentation Time: 2:45 PM - 4:30 PMCorneal sensitivity changes following cross-linking forprogressive lower stage keratoconus©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 - CorneaBelquiz A. Nassaralla 1 , Anelise M. Lago 1 , Larissa Rossana S. Stival 1 ,Joao J. Nassaralla 2 . 1 Cataract Cornea & Refractive Surgery, Institutode Olhos de Goiania, Goiania, Brazil; 2 Retina and Vitreous, Institutode Olhos de Goiania, Goiania, Brazil.Purpose: To evaluate corneal sensitivity changes following cornealcross-linking (CXL) in patients with progressive lower stagekeratoconus.Methods: Thirty eight eyes of 19 patients (11 women, 8 men) wereincluded in a prospective, nonrandomized clinical study. Meanpatient age was 22 years (range, 18-26 years). Inclusion criteria werelow stage bilateral progressive keratoconus, transparent cornea andthinnest corneal thickness ≥ 440 µm. Using the Cochet-Bonnetesthesiometer central corneal sensitivity was measuredpreoperatively, after 7 days, and once a month after surgery untilrecovery of the baseline preoperative level. Normal levels of centralcorneal sensitivity were considered above 40mm.Results: Corneal sensitivity gradually returned to preoperative levelsin all treated eyes. Mean central corneal sensitivity was 52.2, 24.0,38.2, 42.4, 50.0, and 52.4 mm before surgery, at 7 days, and at 1, 2, 3and 4 months after surgery, respectively. Normal levels of cornealsensation, but not baseline preoperative levels, were noted 2 monthsafter surgery. Preoperative levels were observed 3 months aftersurgery.Conclusions: Our results suggest that after CXL for progressivelower stage keratoconus, central corneal sensitivity is decreased foras long as 3 months.Commercial Relationships: Belquiz A. Nassaralla, None; AneliseM. Lago, None; Larissa Rossana S. Stival, None; Joao J.Nassaralla, NoneClinical Trial: NCT01743443Program Number: 5261 Poster Board Number: C0180Presentation Time: 2:45 PM - 4:30 PMImpact of corneal cross-linking on drug penetration in humansChristoph Tappeiner, Markus Tschopp, Kaspar Schuerch, Beatrice E.Frueh. Department of Ophthalmology, Inselspital, UniversityHospital of Bern, Bern, Switzerland.Purpose: To analyze the influence of corneal cross-linking (CXL)with ultraviolet-A and riboflavin on drug permeability using topicallyapplied pilocarpine.Methods: Keratoconus patients (n=10) undergoing standard CXLprocedure with ultraviolet-A (5.4 J/cm2, 30 minutes) and riboflavinon one eye were included in the study. Pupillary diameter measuredbefore and every 3 minutes for 30 minutes after the topicalapplication of one drop of pilocarpine was used as an indirectmeasure for corneal permeability. Pupillary diameter was measuredwith an infrared pupillometer device (Colvard, Oasis Glendora, CA)before (baseline) and 4 months after CXL.Results: Prior to pilocarpine application no significant difference inpupillary diameter was found before CXL and 4 months later(p>0.05). Mean decrease of pupillary diameter 30 minutes after theapplication of pilocarpine was significantly higher at baselinecompared to 4 months follow-up examination (mean decrease of 4.3vs. 3.5 mm; p=0.03).Conclusions: CXL reduces corneal permeability for pilocarpine inhumans.Commercial Relationships: Christoph Tappeiner, None; MarkusTschopp, None; Kaspar Schuerch, None; Beatrice E. Frueh, NoneProgram Number: 5262 Poster Board Number: C0181Presentation Time: 2:45 PM - 4:30 PMApparent progression in children after corneal cross-linking forkeratoconusBeatrice E. Frueh, Christoph Tappeiner. Ophthalmology, Univ ofBern Inselspital, Bern, Switzerland.Purpose: To analyze progression after corneal cross-linking (CXL)in children with keratoconus.Methods: Retrospective evaluation of tomographies (Pentacam) andtopographies (TMS) of prospectively collected data after CXL inchildren younger than 18 years. Examinations were conducted priorto surgery at regular intervals during the first postoperative year, andat 2, 3, and 4 years after the procedure. Twenty-five patients (33eyes) were included in the study. Mean follow-up was 27.3 months,and the minimum follow-up 1 year. Mean age at the time of surgerywas 14.9 years. Progression was defined as an increase in Kmax(Pentacam) of at least one diopter (D) in 1 year.Results: 669 KMax comparisons were made, resulting in theidentification of 4 cases of progression. In one case, the keratoconuswas extremely advanced prior to CXL (Kmax 78.2D before surgeryand 79.3D at 1 year). One case showed marked steepening of 3.4D inthe Pentacam between 3 and 4 years after CXL, but the TMSparameters were unchanged. Because of this discrepancy, thePentacam exam was repeated and showed that Kmax was actuallystable, i.e. no progression after all (50.8D at 3 years and 50.7D at 4years). Two children with active limbal vernal keratoconjunctivitisworsened dramatically (46.4D at 1 year and 48.3D at 2 years; 53.6Dat 1 year and 54.9D at 2 years). This progression was also seen intopography. After resolution of the limbal inflammation, the Kmaxvalues returned to 46.3D and 54.2D, respectively.Conclusions: Our results confirms that CXL is very effective instabilizing keratoconus in children. True progression after CXL couldonly be verified in 1 out of 33 eyes, but that eye had alreadyprogressed to such an extreme extent prior to CXL, that it wasprobaby unrealistic to expect that CXL could arrest progression atsuch a late stage. Further, in assessing possible progression, the useof 2 different measuring devices can help detect discrepancies andthus prevent false conclusions. Moreover, limbal vernal changes canpresent a clinical picture of progression. However, this is actually apseudo-progression, that can be reversed with anti-inflammatorytreatment.Commercial Relationships: Beatrice E. Frueh, None; ChristophTappeiner, NoneProgram Number: 5263 Poster Board Number: C0182©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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