Use of Donors Predisposed by Corneal Collagen Cross-linking in Penetrating Keratoplasty for Treating Patients With Keratoconus

Abstract

It is with great interest that we read the recent publication by Huang and associates 1 Huang T. Ye R. Ouyang C. Hou C. Hu Y. Wu Q. Use of donors predisposed by corneal collagen cross-linking in penetrating keratoplasty for treating patients with keratoconus. Am J Ophthalmol. 2017; 184: 115-120 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar on “Use of donors predisposed by corneal collagen cross-linking in penetrating keratoplasty of treating patients with keratoconus,” in which they presented data from a randomized controlled trial and showed that cross-linking donor corneas prior to penetrating keratoplasty for keratoconus resulted in improved vision with a moderate reduction in refractive error. We were pleased to see that these clinical observations supported our earlier laboratory-based research, with which the authors may not be familiar, 2 Mukherjee A. Hayes S. Aslanides I. Lanchares E. Meek K.M. Donor cross-linking for keratoplasty: a laboratory based evaluation. Graefes Arch Clin Exp Ophthalmol. 2015; 253: 2223-2228 Crossref PubMed Scopus (7) Google Scholar but which we believe was the first publication to evaluate the concept of donor cross-linking prior to keratoplasty. In 2015, we performed ex vivo penetrating keratoplasty on 30 porcine corneas, with 15 undergoing conventional keratoplasty and 15 undergoing keratoplasty with cross-linked donor corneas. Some of the main findings from our study were that the postoperative wavefront astigmatism and higher-order aberrations, more so than the mean keratometric astigmatism, were significantly reduced in the cross-linked procedure. Our theoretical expectation, based on the findings of the study, was that donor cross-linking would primarily reduce irregular astigmatism and higher-order aberrations induced by sutures. It is therefore unfortunate that these parameters were not evaluated by Huang and associates, as they may have helped to explain the significant improvements in visual acuity that they observed following keratoplasty with cross-linked donor tissue, despite only modest changes in regular astigmatism. Use of Donors Predisposed by Corneal Collagen Cross-linking in Penetrating Keratoplasty for Treating Patients With KeratoconusAmerican Journal of OphthalmologyVol. 184PreviewTo investigate whether use of donors predisposed by corneal collagen cross-linking (CXL) reduced myopic refractive errors for keratoconic eyes after penetrating keratoplasty (PK). Full-Text PDF ReplyAmerican Journal of OphthalmologyVol. 188PreviewOur recent study1 concluded that use of donors predisposed by corneal collagen cross-linking could reduce topographic readings after penetrating keratoplasty for the treatment of keratoconus, and consequently reduce myopic refractive errors and improve visual acuity. We appreciate the comments from Hayes and associates.2 It is meaningful and delightful to discuss the clinical observations and laboratory data. Here we respond to the comments. Full-Text PDF