Deep Anterior Lamellar Keratoplasty Using Irradiated Acellular Cornea with Amniotic Membrane Transplantation for Intractable Ocular Surface Diseases

Abstract

PurposeTo report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) when sterile gamma-irradiated acellular corneal tissues (VisionGraft) are used in combination with amniotic membrane transplantation (AMT) for intractable ocular surface diseases.MethodsThe medical records of fifteen patients who had DALK with AMT were retrospectively reviewed. Indications for surgery included ocular burn, bacterial keratitis, herpes simplex virus keratitis, corneal opacity with Stevens-Johnson syndrome, Mooren's ulcer, idiopathic myxoid degeneration of corneal stroma, and recurrent band keratopathy. DALK was performed using partial-thickness acellular corneal tissue and a temporary amniotic membrane patch was added at the end of the operation.ResultsAll cases that underwent DALK with AMT became epithelialized within 2 postoperative weeks. Twelve patients showed favorable outcomes without graft rejection, corneal opacification, or neovascularization. The other three grafts developed corneal opacification and neovascularization, and required additional penetrating keratoplasty (PK). Unlike the results of previous PKs, there were no graft rejections and the graft clarity was well-maintained in these three cases for at least 8 months after PK.ConclusionsDALK using sterile acellular corneal tissues in combination with AMT may be a good therapeutic strategy for treating intractable ocular surface diseases because of lowered immune rejection, fibroblast activation, and facilitation of epithelialization. Furthermore, DALK can help stabilize the ocular surface, prolong graft survival, and may allow better outcomes when combined with subsequent PK.

Cross-linked decellularized porcine corneal graft for treating fungal keratitis

“…γ-ray irradiation works by directly destroying DNA and causing indirect damage via reactive oxygen species (ROS) generation 26, 27 . Recent studies have reported that the γ-irradiated sterile decellularized cornea can be effectively applied to lamellar keratoplasty 28–30 . The combined use of polyethylene glycol and γ-ray irradiation makes the maximal decelluarization effect, because neither porcine endogenous retroviral DNA sequence nor alpha-1,3 galactose epitope was detected after treatment 31 .…”

Effects of gamma radiation sterilization on the structural and biological properties of decellularized corneal xenografts

“…GI has also been applied successfully to human corneas. Most of patients that received a gamma irradiated human cornea showed favorable outcomes without graft rejection, loss of transparency or neovascularization [30]. Moreover, GI might reduce allogenicity [31], with the added advantage of a shelf life of the sterile irradiated human cornea for more than one year at room temperature [32].…”

Long-term clinical outcomes of keratoplasty using gamma-irradiated corneal lenticules

“…In fact sterile corneas may provide better visual acuity for anterior lamellar procedures due to a smoother interface than do fresh tissues for laser-assisted lamellar anterior keratoplasty 21. Wee et al 22 reported excellent outcomes when using the combination of irradiated acellular cornea with amniotic membrane transplantation (AMT) in patients with intractable ocular surface diseases. They noted that AMT facilitated epithelial healing, and ultimately better graft survival.…”