Tectonic lamellar keratoplasty with acellular corneal stroma in high-risk corneal transplantation

[摘要] Purpose: Tectonic lamellar keratoplasty(TLKP) is a primary surgical procedure to improve the condition of therecipient bed in high-risk corneal transplantation. It is usuallyperformed for a secondary optical penetrating keratoplasty (PKP). Thepresent study was undertaken to explore a new strategy for TLKP usingacellular corneal stroma (ACS) prepared by decellularization. Methods: ACS for TLKP was prepared fromcat cornea by decellularization. The efficiency of thedecellularization was examined by hematoxylin and eosin (H&E)staining and through DNA content analysis. Twenty-eight New Zealandwhite rabbits, as recipients, were assigned to one of two groups thathad different material for their TLKP. The TLKP was combined with acentral optical PKP as a single-stage procedure. Either ACS or freshcat corneal lamella, 11.25 mm in diameter, was used for the TLKP inthese two groups. After TLKP, a 6.5-mm full-thickness cat cornea wasplaced in the central cornea of each recipient rabbit for PKP. Clinicaloutcomes and the histology of the transplants were comparedpost-operatively. Results: ACS for TLKP prolonged thesurvival of the transplants. The mean survival time of the transplantsin the ACS group (36.4±4.3 days) was longer than for those in thecontrol group (14.0±2.2 days, p<0.05). The ACS group showed asignificantly smaller neovascularization area compared to the controlgroup. The areas of corneal neovascularization were 5.3±1.1 mm2and 45.2±4.9 mm2 (p<0.05), respectively, after two weeks,and 25.1±4.7 mm2 and 105.3±12.4 mm2 (p<0.05),respectively, after four weeks. Histology revealed that fewerinflammatory cells were infiltrating the transplants in the ACS groupthan those in the control group. Conclusions: The use of ACS for TLKPprolonged the survival of corneal transplants, reduced cornealneovascularization, and prevented from infiltration of inflammatorycells. It is a feasible and effective strategy to prolong the survivalof transplants in high-risk corneal transplantation.

[学科分类] 生物化学/生物物理