Deep Anterior Lamellar Keratoplasty Using Acellular Corneal Tissue for Prevention of Allograft Rejection in High-risk Corneas

Li, Jinyang; Yu, Le-chu; Deng, Zifeng; Wang, Lihua; Lee, Sun; Ma, Haijun; Chen, Wei

doi:10.1016/j.ajo.2011.05.002

Cited by 49 publications

(56 citation statements)

References 39 publications

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“…This method could prevent allograft rejection and promote graft survival rate in high-risk corneas. 9 Applying 0.2% cyclosporine A eye drops after surgery may also maintain graft health, 17 as well as decrease the recurrence rate of AKC.…”

Section: Discussionmentioning

confidence: 99%

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Surgical treatment of 32 cases of long-term atopic keratoconjunctivitis using the amniotic membrane

Yang

Fh²,

et al. 2013

Eye

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Section: Discussionmentioning

confidence: 99%

“…AM and glycerolpreserved corneal patch grafts were prepared as previously described. 8,9 All membranes and grafts were screened by blood serum testing to exclude the human immunodeficiency virus, hepatitis virus type B, hepatitis virus type C, and syphilis.…”

Section: Methodsmentioning

confidence: 99%

Surgical treatment of 32 cases of long-term atopic keratoconjunctivitis using the amniotic membrane

Yang

Fh²,

et al. 2013

Eye

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“…Long-term preserved corneas with mean storage time between 2.7 and 9.6 months are also used for DALK by some surgeons [22][23][24][25]. Frequently, lyophilization or chemical agents are used to dehydrate corneas before cryopreservation [22][23][24]. However, it is possible to employ cryopreservation without dehydration before freezing as indicated by one study [25].…”

Section: Type and Quality Of Donors Used For Pk And Dalkmentioning

confidence: 99%

“…Another DALK study used donors with the following features: age between 28 and 88 years, ECD between 100 and 3300 cells/mm 2 , and storage time up to 35 days in organ culture medium (31°C) [21]. Long-term preserved corneas with mean storage time between 2.7 and 9.6 months are also used for DALK by some surgeons [22][23][24][25]. Frequently, lyophilization or chemical agents are used to dehydrate corneas before cryopreservation [22][23][24].…”

Section: Type and Quality Of Donors Used For Pk And Dalkmentioning

confidence: 99%

“…The acceptable conditions for PK donors are donor age varying from 1 to 96 years [9][10][11][12][13][14][15][16], endothelial cell density between 2000 and ≥ 3000 cells/mm In contrast to penetrating keratoplasty, donors with quality ranging from fair to excellent are employed for DALK [20,21]. Furthermore, long-term preserved donor tissues completely devoid of cells are also transplanted [22][23][24][25]. One DALK study used donor cornea tissues with age between 12 and 72 years, graft rating from fair to excellent, endothelial cell density (ECD) between 1128 and 4255 cells/mm 2 , death-to-preservation time up to 56 hours, and storage time up to 13 days in Optisol medium (-4°C) [20].…”

Section: Type and Quality Of Donors Used For Pk And Dalkmentioning

confidence: 99%

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Donor Graft Quality Used for Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Feizi¹

2016

Advances in Eye Surgery

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Deep anterior lamellar keratoplasty (DALK) has been recently introduced as an alternative to penetrating keratoplasty (PK) for corneal pathologies not involving corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, it provides a greater availability of donor corneas that do not need perfectly healthy endothelium and high endothelial cell density to be suitable for PK. Furthermore, as lamellar corneal surgery expands the potential use of acellular corneal tissue, long-term preservation techniques are being revisited as a way to increase availability of corneal tissue to alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in the technique of corneal transplantation and hence the type of donor cornea tissues used for each technique, may require eye banks and corneal surgeons to reassess their selection criteria but it is important for any changes to be evidence-based. The purpose of this chapter, therefore, is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, to evaluate the impact of donor and eye bank variables on the suitability of corneas for transplantation and then go on to determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.

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Protectively Decellularized Porcine Cornea versus Human Donor Cornea for Lamellar Transplantation

Shi

Zhou

Gao

et al. 2019

Adv Funct Materials

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Decellularization can reduce the immune barrier of xenotransplantation, but tissue swelling‐caused structural and functional damage remains unsolved, including corneal transparency loss after decellularization. Here, a protective decellularization strategy is developed for the preparation of decellularized porcine cornea (DPC), in which corneas are treated by detergent and endonuclease in the protective medium with 50 mmHg colloid osmotic pressure. A nonrandomized open‐label trial is conducted to evaluate the clinical outcome of lamellar transplantation with DPC versus human donor cornea (HDC) as grafts. Through the protective corneal decellularization, major xenoantigen DNA and α‐gal are efficiently removed, while corneal original structural and transparency characteristics are preserved. Among the 23 patients with DPC transplantation for 12 months, 22 grafts survive without ulcer recurrence or immune rejection, 1 graft demonstrate melting. Compared with HDC grafts, DPC grafts showed early suture loosing, but no complication is observed with timely removal. The epithelial regeneration rate, graft transparency restoration, best‐corrected visual acuity improvement, and mechanical properties achieve equivalent levels compared with that of HDC grafts. Collectively, the results suggest that the porcine cornea through protective decellularization may provide an effective “off‐the‐shelf” substitute of globally‐shortened human donor tissue for lamellar transplantation.

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Deep Anterior Lamellar Keratoplasty Using Acellular Corneal Tissue for Prevention of Allograft Rejection in High-risk Corneas

Cited by 49 publications

References 39 publications

Surgical treatment of 32 cases of long-term atopic keratoconjunctivitis using the amniotic membrane

Surgical treatment of 32 cases of long-term atopic keratoconjunctivitis using the amniotic membrane

Donor Graft Quality Used for Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Protectively Decellularized Porcine Cornea versus Human Donor Cornea for Lamellar Transplantation

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