Sutureless Lamellar Keratoplasty Research Articles

Natural Extracellular Matrix Scaffold-Based Hydrogel Corneal Patch with Temperature and Light-Responsiveness for Penetrating Keratoplasty and Sutureless Stromal Defect Repair.

Corneal transplantation remains the gold standard for treating corneal blindness; however, it is hampered globally by donor shortages and the complexity of suture-dependent procedures. Tissue-engineered corneas have demonstrated potential as corneal equivalents. Nevertheless, the development of adhesive corneal patches and full-thickness corneal substitutes remains challenging. In this study, a multifunctional hydrogel corneal patch (MHCP) is constructed by integrating a dual-crosslinked hybrid hydrogel with temperature and light responsiveness with a natural extracellular matrix scaffold. When applied to the ocular surface, MHCP spontaneously releases adhesives at body temperature and forms a stable adhesion with the recipient cornea through photocuring. In addition to its inherent mechanical, optical, and ultrastructural characteristics, which are similar to those of the natural stroma, MHCP demonstrates excellent suture resistance, anti-swelling, and anti-degradation properties after curing. MHCP promotes the proliferation and migration of corneal epithelial cells in vitro and maintains the phenotype of corneal stromal cells. In vivo, MHCP maintains graft hydration and restores corneal structural integrity and transparency during penetrating keratoplasty of various sizes and sutureless lamellar keratoplasty. Collectively, given the advantages of native stroma-like characteristics, operation-facilitating multiple functions, and convenient preparation, MHCP is a promising corneal substitute for clinical applications.

Fibrin glue-assisted lamellar keratoplasty for the treatment of corneal ulcer

To investigated the feasibility of fibrin glue-assisted sutureless lamellar keratoplasty (LK) in patients with corneal ulcer. Noncomparative interventional case series. In 21 eyes of 21 patients with terriens marginal degeneration (TMD) or corneal ulcer after trauma, sutureless lamellar keratoplasty (LK) using fibrin glue was performed. Postoperatively, the graft status, graft clarity, the visual prognosis and postoperative complications were recorded. There were 16 cases suffered with Terriens marginal degeneration (TMD) and 5 cases with corneal ulcer after foreign body removed. All the corneal ulcers were successfully healed after the procedure, the operative complications included corneal perforation during operation in 1 case, recurrence of TMD in 1 case and graft opacity in 2 cases. There was no graft dislocation, hydrops between graft and recipient interface, secondary infection and graft rejection after surgery, 19 cases had improved best-corrected visual acuity (BCVA) while 2 cases had poor vision acuity due to graft opacity (t = -2.587, P = 0.018). Fibrin glue-assisted sutureless LK showed excellent graft stability in all patients.

Use of tissue adhesives in ophthalmology

Use of tissue adhesives in ophthalmology

Sutureless lamellar keratoplasty by microkeratome combined with fibrin tissue adhesive in rabbits

To evaluate the feasibility and safety of sutureless lamellar keratoplasty by microkeratome combined with fibrin tissue adhesive. Twenty-four New Zealand white rabbits were divided into two groups, the donor grafts and recipient beds were made by the microkeratome, the grafts were glued over the stoma bed using the commercial product Tisseel in one group; and grafts without tissue adhesive were used as the control group. Corneal refractive power was measured by automated keratometer preoperatively and in 3 days, 2 weeks, 1 and 3 months postoperatively. Rejection and cornea transparency were observed. Confocal microscopy was used to observe corneal wound healing response and to measure the keratocyte and endothelium densities in vivo. Corneal wound healing was also evaluated using light and fluorescence microscopy. Ninety-two percent (11/12 eyes) of the glued grafts were retained in the Tisseel group, whereas all grafts were lost in the control group. All survived grafts were clear 1 month after surgery. However, in the control group, severe haze in the grafts occurred 2 weeks postoperatively. Confocal microscopy showed that there was a significant decrease of the keratocyte density surrounding the lenticule-host interface, and no changes occurred in the posterior keratocyte and endothelium. Histopathologic observations demonstrated the presence of a line of amorphous eosinophilic substance in the lenticule-host interface at 3 days after surgery, but the line disappeared after 1 month. Fluorescence microscopy showed no detectable regenerated stromal tissue. This initial study demonstrates sutureless optical lamellar keratoplasty performed by microkeratome combined with fibrin tissue adhesive is a simple and safe technique. Stromal wound healing response to this surgery is minimal. Fibrin tissue adhesive has no influence on the cornea optical property.

Human fibrin tissue adhesive for sutureless lamellar keratoplasty and scleral patch adhesion: a pilot study

Purpose To determine whether a fibrin adhesive can facilitate the performance of sutureless lamellar keratoplasty and attachment of amnion to bare sclera. Design Prospective, noncomparative case series. Participants Six patients, 5 of whom underwent lamellar keratoplasty and 1 who received an amniotic patch of the sclera and cornea. Institutional review board approval was not required for these therapeutic treatments. Methods In 5 patients, the epithelium was removed from the corneal surface, a free cap, 200-μm thick, was cut with a microkeratome, and a human fibrin tissue adhesive (Tisseel VH Fibrin Sealant; Baxter Healthcare Corporation, Glendale, CA) was applied to the cut surface of the corneal stroma. A 200-μm thick, microkeratome-cut lamellar graft was placed in the stromal bed without sutures, and a bandage soft contact lens was applied. The lens was left in place for 1 week and then removed. In 1 patient, the adhesive was applied to bare sclera for attachment of amniotic membrane after removal of a conjunctival melanosis. All patients were followed up for 3 months after surgery. Main outcome measures Tissue adhesion, corneal clarity, and visual acuity. Results All 5 lamellar grafts healed and remained clear, although final visual acuity varied with visual potential and astigmatism. The amniotic membrane graft also adhered well to the bare sclera. Conclusions The fibrin adhesive provided satisfactory attachment without sutures for lamellar keratoplasty and amniotic patching. It should be effective for sealing of clear cornea incisions, LASIK flaps, and conjunctival and skin grafts. An adhesive that has been designed specifically for ophthalmic applications and is more convenient to use would be desirable.

Effects of tissue adhesive (Tisseel) on corneal wound healing in lamellar keratoplasty in rabbits.

The purpose of this study was to compare corneal wound healing between suture and sutureless lamellar keratoplasty in the rabbit eye. The tissue adhesive (Tisseel, Vienna) a commercially available two component adhesive system based on human fibrinogen, which is activated by thrombin, was used. 8.0mm half-thickness lamellar keratoplasties (autotransplants) were performed on the twenty-four rabbit eyes with tissue adhesive and the other eyes were operated with 10-0 nylon continuous suture as a control, respectively. At varying periods postoperatively, they were killed and the eyes were immediately enucleated and examined by transmission electron microscopy and light microscopy. The procedure was completed by the application of a bandage soft contact lens. Seventy-one percent of the glued lamellar keratoplasty grafts were retained and in six eyes, focal white opacities at the bed and graft interface were noted. There was no change in corneal contour, with the only irregularity being at the graft/host junction in the tissue adhesive group. Histopathologic examination of the glued eyes demonstrated the presence of a layer of eosinophilic material between the corneal bed and the lamellar graft but a minimal inflammatory response was observed in the early postoperative days. At fourteen days the adhesive was no longer visible and at three weeks, the graft was well healed. We believe that this study indicates a potential adjunctive role for tissue adhesive in corneal wound healing.