Keratoplasty overview

An Overview on Keratoplasty

Dr Geetha K V

Changing trends in keratoplasty Mythology

Saint Lucy 283-304 AD Patron saint in

ophthalmology

Theories

130-200AD

• Galen• Abrasio cor’naea

1789 1796

• Guillaume Pellier de Quengsy- transparent material can restore vision

• Erasmus Darwin- proposed 1st trephine and postulated transparent scar

1817

• Establishment of Ophthalmology as the 1st surgical s subspecialty and foundation of Moorfields Eye Hospital, London.

Practice

18131818

1835

1838

1867

1888

• Karl Himley- advocated use of animal cornea

• Franz Reisinger (his student)- applied it, termed Keratoplasty• Samuel Bigger (Irish Surgeon)- 1st successful penetrating allograft in a pet gazelle

• Richard Kisam performed the 1sttherapeutic corneal xenograft on a human eye

• Henry Power(England) penetrating keratoplasty with allograft

• Arthur Von Hippel- Lamellar xenografts, invented clockwork trephine

Mark of Modern Era 1905- Edward Zirm

performed the 1st successful human allograft

Recommended1. Exclusive use of human

corneas2. Use of Von Hippel trephine3. Deep anaesthesia4. Asepsis5. Overlay sutures6. AC maintainer use7. Avoid touching tissue8. Place graft in moist gauze

Elschnig

1930

suggests cadeveric tissue use

Ramon Castroviejo

1932Invented instruments, circular grafts, direct

sutures

Vladimir Filatov

1931popularised

cadeveric tissue use

Various landmarks 1957 early use of corticosteroids in animal models of corneal

transplant

1952 Stocker notes importance of endothelium in corneal hydration

1953 Zeiss introduces 1st commercially available operating microscope

1960 Mackenson and Harms introduced ophthalmic nylon sutures

1968 Ethicon develops 10/0 nylon specifically for keratoplasty

1980 10 year success all over world of PKP for keratoconus recorded to be >90%

Leading to…

1. Eye bank establishment

2. EK and its modifications

3. ALK and its modifications

4. Kerato prosthesis

Eye Bank Development

1931• Vladimir Filatov (Russian)• Use of cadaver corneas

1944• Richard Paton (American)• Established 1st eye bank in New York

1955• Committee of eye banks was formed• Representing 12 eye banks all over USA

1961• Committee renamed as Eye Bank Association of

America (EBAA) and it established various training programs for technicians

Endothelial Keratoplasty and its modifications

1999

Mark Terry Modified PLK to DLEK

1998Gerrit Melles PLK, air bubble for

self adhesion

1956Charles Tillet 1st endothelial

keratoplasty

2006

Gerrit Melles DMEK technique introduction

2005Mark Gorovoy

Renamed DSEK to DSAEK after

introduction of microkeratome

2004Gerrit Melles

Modified DLEK to DSEK with

descematorrhexis

ALK and its modifications 1970

• Malbran and gasset were performing DALK

1985• Archila modified DALK, used air to separate corneal

layers

1989, 1992• Price, Chan

• Reported on DALK and said more refinement was required

2002• Anwar and Teichmann introduced ‘big bubble’

pneumodissection technique for DALK

FLAK- Femtosecond Laser Assisted Keratoplasty Femtosecond lasers: evolution

of keratoplasty would not be complete without a mention of this. to perform accurate corneal trephination for donor and recipients.

It is being used to begin trephination at a predetermined depth individualized for patients cornea

Has provided the flexibility to create shaped grafts that allow exact matches between donor and recipient, thus necessitating fewer sutures.

Customized trephination patterns with femtosecond laser-enabled keratoplasty. A, Standard ''butt-joint''B, ''top-hat''C, ''mushroom''D, ''zig-zag''E, ''Christmas tree.''

Keratoprosthesis Keratoprosthesis, the

transplantation of an artificial cornea, was first performed in Italy by Benedetto Strampelli the 1960s

Historical options have included the osteoodontokeratoprosthesis (OOKP) and AlphaCor artificial cornea. These have since been largely replaced by the Boston Type I Keratoprosthesis (KPro), which became approved for use by the U.S. Food and Drug Administration in 1992

Summary

Recent AdvancesBioengineered Corneas

Human Corneal Endothelial cell culture

In 2015, the world's first artificial bioengineered cornea was approved by CFDA( chinese FDA) to be applied clinically as a substitute for human cornea in lamellar keratoplasty.

‘ACORNEA’ is made using tissue engineering technique on porcine cornea to preserve collagen architecture of the corneal matrix so that it can quickly integrate with patients' corneal tissue. The transplanted cornea will gradually become transparent, thus leading to a recovery of patients' vision.

The new endothelial cell growth method developed by schepens eye research institute in masachussets, uses an agent that interrupts cell-to-cell contact. In addition, the medium contains growth factors that promote the proliferation of corneal endothelial cells.

may be implanted either as a monolayer or by injection into the anterior Chamber in future as a replacemenr or as an additive to keratoplasty

Thank You