Refining Corneal Trephination and Donor Preparation for Artificial Cornea

Surgery

World Cornea Congress VIIApril 15 - 17 2015, San Diego 2015

Behrooz Azizi, MD; Ronan Conlon, MD; Salina Teja. MD; Joshua C Teichman, MD, MPH; Season Yeung, MBBS, FRANZCO;

Setareh Ziai, MD, FRCSC; Kashif Baig, MD, MBA, FRCSCUniversity of Ottawa Eye Institute, Ottawa, Ontario, Canada

Financial Disclosures

Drs. Azizi, Conlon, Teja, Yeung, Teichman, & Ziai have no financial relationships to disclose

Dr. Baig has the following relationships:

Financial Interest/ Affiliation Name of Company(s)

Grant/Research Support Allergan, Bausch & Lomb, Merck, Moria

Employment/Honoraria/Consulting Fees/Travel Expenses Alcon, Allergan, Bausch & Lomb, Labtician

Major Stock Shareholder None

Member: Advisory Panel, Standing Committee, Board of Directors Allergan, Bausch & Lomb

Other Financial or Material Interest None

Introduction

Corneal transplantation is a standard surgical treatment for many corneal diseases

However, there are situations in which replacement of the diseased cornea is best managed with an “artificial cornea”

The Boston keratoprosthesis (Kpro) is the most commonly utilized artificial cornea

Difficulty in achieving concentric punches

Khalifa YM, Moshirfar M. Improved centration of the type 1 Boston Keratoprosthesis in donor carrier tissue. Clin Ophthalmol. 2010 Aug 19;4:931-3

Difficulty in achieving concentric punches

Khalifa YM, Moshirfar M. Improved centration of the type 1 Boston Keratoprosthesis in donor carrier tissue. Clin Ophthalmol. 2010 Aug 19;4:931-3

Difficulty in achieving concentric punches

John T. Use of trypan blue corneal staining and centration ring in Boston keratoprosthesis surgery. Techniques in Ophthalmology. 2009 Dec. 7(4):127-130

Purpose

To devise a simple and cost-effective device for the preparation of the donor corneal tissue for Kpro surgery.

This device will perform the outer 8mm and inner 3mm cuts with increased accuracy and precision to improve centration.

Methods 30 donor corneas that were not suitable for transplantation

3 arms (1:1:1 design) 3mm followed by 8mm punch 8mm followed by 3mm punch Paired 3mm & 8mm punches utilizing the prototype

Computer software (Adobe Photoshop, San Jose, CA) was used to measure the centration of the punches by a masked examiner

Descriptive & inferential statistics were performed

Methods

Results – Decentration

Error bars = ± SEM

* P<0.0001

Results – Decentration

Range (mm) Avg (mm) SD (mm)

8mm 3mm 0.22 - 0.57 0.39 0.11 3mm 8mm 0 - 0.20 0.13 0.06 Paired 0 - 0.22 0.11 0.09

Conclusions

Our study demonstrates that pairing the two trephinations on the donor cornea with the use of a single device leads to increased predictability & ease of trephination