GRAFT STABILITY AFTER ENDOTHELIAL KERATOPLASTY
Abstract
Aim: To establish the graft stability after Descemet stripping with endothelial keratoplasty (DSEK), compare it to the graft stability after endothelial keratoplasty (EK) with the intact posterior corneal layers in the rabbit cornea, and to investigate the nature of wound healing. Methods: Adult white rabbits were used( N=20), divided in two experimental groups. Ten rabbits underwent monocular DSEK, and ten, EK without Descemet stripping. On the second postoperative day Lindstrom roller was used to try to dislocate graft horizontally in each animal, and corneas were processed for the light microscopy study.
Results: Rolling the Lindstrom instrument over the corneal surface did not cause horizontal dislocation in any of the operated eyes. In the DSEK group light microscopy revealed the lack of inflammation and fibrosis at the donor – recipient interface (DRI), but was distinctive on histology. Retrocorneal membrane was found in two eyes. In the group with EK only, the host Descemet`s membrane (DM) was intact without endothelial cells, with good graft apposition, without inflammation or fibrosis, and there was no retrocorneal membrane.
Conclusion: This study suggests that there is no difference in graft stability in DSEK compared to EK without DM stripping in rabbit corneas. The wound healed at DRI by hypocellular scarring only, in both experimental groups.
References
Fujikawa LS, Foster CS,Harrist TJ, Lanigan JM, Colvin RB. Fibronectin in healing rabbit corneal wounds, Lab Invest 1981; 45: 120-9
Ivaresen A, Laurberg T, Møller-Pedersen T. Characterisation of corneal fibrotic wound repair at the LASIK flap margin. Br J Ophthalmol 2003;87:1272-8
Kato T, Nakayasu K, Hosoda Y, Watanabe Y, Kanai A. Corneal wound healing following laser in situ keratomileusis (LASIK) : a histopathological study in rabbits. Br J Ophthalmol 1999;83:1302-5
Kim EK, Cristol SM, Geroski DH, McCarey BE, Edelhauser HF. Corneal Endothelial Damage by Air Bubbles During Phacoemulsification. Arch Ophthalmol 1997;115:81-8
Laurent JM, Schallhorn SC, Spigelmire JR, Tanzer DJ. Stability of the laser in situ keratomileusis corneal flap in rabbit eyes. J Cat Ref 2006;32:1046-51
Melles GR, Binder PS, Beekhuis WH, Wijdh RH, Moore MN, Anderson JA, SundarRaj N. Scar tissue orientation in unsutured and sutured corneal wound healing. Br J Ophthalmol 1995;79:760-8
Miyamoto T, Saika A, Yamanaka A,kawashima Y, Suzuki Y, Ohnishi Y. Wound healing in rabbit corneas after photorefractive keratectomy and laser in situ keratomileusis. J Cat Ref Surg 2003;29:153-8
Quantock AJ, Padroni S, Connon CJ, Milne D, Schanzlin DJ. Proteoglycan alterations in the rabbit corneal stroma after a lamellar incision. J Cataract Refract Surg 2003;29:821-4
Suda T, Nishida T, Ohashi Y, Nakagawa S, Manabe R. Fibronectin appears at the site of corneal stromal wound in rabbits. Curr Eye Res 1981;1:553-6
Wilson SE. Analysis of the keratocyte apoptosis, keratocyte proliferation, and myofibroblast transformation responses after photorefractive keratectomy and laser in situ keratomileusis. Trans Am Ophthalmol Soc 2002;100:411-33
Lee DA, Wilson RM, Yoshizumi MO, Hall M. The ocular effects of Gases When Injected Into the Anterior Chamber of Rabbit Eyes. Arch Ophthalmol 1991;109:571-5
Michels RG, Kenyon KR, Maumenne E. Retrocorneal fibrous membrane. Invest Ophthalmol Vis Sci 1972;11:822-31
Nikolic Lj, Friend J, Taylor S, Thoft R. Inhibition of vascularization in Rabbit Corneas by Heparin: Cortisone Pellets. Invest Ophthalmol Vis Sci 1986;27:449-56
Sherrard ES, Rycroft PV. Retrocorneal membranes I . Br J Ophthalmol 1967;51:387-93
Sherrard ES, Rycroft PV. Retrocorneal membranes II . Br J Ophthalmol 1967;51:379-86
Thomson RW, Price MO, Bowers PJ, Price FW Jr, 2003, Long term graft survival after penetrating karatoplasty. Ophthalmology 2003;110:1396-402
Patel NP, Kim T, Rapuano CJ, Cohen EJ, Laibson PR. Indications for and outcomes of repeat penetrating keratoplasty, 1989 – 1995. Ophthalmology 200;107:719-24
Weisbrod DJ, Sit M, Naor J, Slomovic AR. Outcomes of repeat penetrating keratoplasty and risk factors for graft failure. Cornea 2003;22:429-34
Van Horn DL, Sendele DD, Seideman S, Buco P. Regenerative capacity of the corneal endothelium in rabbit and cat. Invest Ophthalmol Vis Sci 1977;16(7):597-613
Heindl LM, Hofmann-Rummelt C, Schlötzer-Schrehardt U, Kruse FE, Cursiefen C. Histologic Analysis of Descemet Stripping in Posterior lamellar Keratoplasty. Arch Ophthalmol 2008;126:461-7
Caldwell M, Afshari N, Decroos F, Proia A. The histology of graft adhesion in descemet stripping with endothelial keratoplasty. Am J Ophthalmol 2009:148:277-81
Shulman J, Kropinak M, Ritterband D, Perry H, Seedor J, McCormick et al., 2009, Failed descemet-stripping automated endothelial keratoplasty grafts: a clinicopathologic analysis. Am J Ophthalmol 2009;148:752-9
Suh LH, Yoo SH, Deobhakta KE, Alfonso EC, Culbertson WW. Complications of Descemet’s stripping with automated endothelial keratoplasty : survey of 118 eyes at one institute. Ophthalmology 2008;115:1517-24
Bansai RA, Das P, Sukhija J, Jain AK. Intracorneal epithelial ingrowth after descemet stripping endothelial keratoplasty and stromal puncture. Cornea 2009;28:334-7
Price FW, Price MO. Descemet’s stripping with endothelia keratoplasty in 50 eyes : a refractive neutral corneal transplant. J Ref Surg 2005;21:339-45
Price FW Jr, Price MO. Descemet’s stripping with endothelial keratoplasty in 200 eyes: Early challenges and techniques to enhance donor adherence. J Cat Ref Surg 2006 32:411-8
Kim JY, Kim MJ, Kim T, Choi H, Pak JH, Tchah H. A femtosecond Laser Creates a Stronger Flap than a Mechanical Microkeratome. Invest Ophthalmol Vis Sci 2006;47:599-604
Terry MA, Hoar KL, Wall J, Ousley P. Histology of dislocations in endothelial keratoplasty (DSEK and DLEK): a laboratory-based, surgical solution to dislocation in 100 consecutive DSEK cases. Cornea 2006;25:926-32
Sbarbaro JA, Eagle RC, Thumma P, Raber IM. Clinical and histopathologic features of failed descemet stripping automated endothelial keratoplasty grafts. Cornea 2009;28:530-5
Obata h, Tsuru T. Corneal wound healing from the perspective of keratoplasty specimens with special reference to the function of the Bowman layer and descemet membrane. Cornea 2007;26(9 suppl 1):S82-9
Sherrard ES. Further studies on retrocorneal membrane-endothelium relationship. Br J Ophthalmol 1969;53:808-18
Faia LJ, Baratz KH, Bourne WM. Corneal graft folds: a complication of deep lamellar endothelial keratoplasty. Arch ophthalmol 2006;124:593-5
Melles GR. DLEK to DSEK to DMEK. Cornea 2006;25:279-81
Melles GRJ, Eggink FA. A Surgical Technique for Posterior Lamellar Keratoplasty. Cornea 1998;17:618-26
McCulloch C, Thompson GA, Basu PK. Lamellar keartoplasty using full thickness donor material. Tr Am Ophth Soc 1963;61:154-80
Price FW Jr, Price MO. Endothelial keratoplasty to restore clarity to a failed penetrating graft. Cornea 2006;25:895-9
Nikolic Lj, Jovanovic V, Lackovic V, Todorovic V. Endothelial keratoplasty without Descemet’s membrane stripping: histologic and ultrastructural findings. Ophthalmic Res 2010;43:56-60
Hatanaka H, Koizumi N, Okumura N, Takahashi H, Tanioka H, Young RD, Jones FE, Quantock AJ, Kinoshita S. A study of host endothelial cells after non-Descemet stripping automated endothelial keratoplasty. Cornea 2013;32:76-80
Park CY, Chuck R. Non-Descemet Membrane Endothelial Keratoplasty. Cornea 2013;32:1607-8
Masaki T, Kobayashi A, Yokogawa H, Saito Y, Sugiyama K. Clinical outcome of non-Descemet stripping automated endothelial keratoplasty ( nDSAEK). Jpn J Ophthalmol. 2012;56:203-7
Chaurasia S, Ramappa M, Sangwan V. Clinical outcome of non-Descemet stripping automated endothelial keratoplasty. Int Ophthalmol 2012;32:571-5
Folkman J, Klagsbrun M, Sasse J, Wadzinski M,Ingber D,Vlodavsky I. A heparin-binding angiogenic protein – basic fibroblast growth factor – is stored within basement membrane. Am J Pathol 1988;130:393-400
