Deep Anterior Lamellar Keratoplasty Using Acellular Corneal Tissue for Prevention of Allograft Rejection in High-risk Corneas

• Published in: American journal of ophthalmology Vol. 152; no. 5; pp. 762 - 770.e3
• Main Authors: Li, Jinyang, Yu, Lechu, Deng, Zifeng, Wang, Lihua, Sun, Li, Ma, Huixiang, Chen, Wei
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2011; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Bone marrow; Cell Count; Cornea; Corneal Diseases - physiopathology; Corneal Diseases - surgery; Corneal Transplantation - methods; Double-Blind Method; Endothelium, Corneal - cytology; Eye Burns - physiopathology; Eye Burns - surgery; Eye Infections - physiopathology; Eye Infections - surgery; Eyes & eyesight; Female; Glycerol - therapeutic use; Graft Rejection - prevention & control; Graft Survival - physiology; Herpes viruses; Humans; Male; Medical sciences; Microscopy, Confocal; Middle Aged; Miscellaneous; Ophthalmology; Organ Preservation; Prospective Studies; Tissue Donors; Transplantation, Homologous; Transplants & implants; Visual Acuity - physiology; Young Adult; Prevention; Rejection; Graft(material); High risk; Tissue; Cornea; Anterior; Lamellar graft; Homograft; Ophthalmology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2011.05.002

Purpose To determine whether deep anterior lamellar keratoplasty (DALK) using acellular glycerol-cryopreserved corneal tissue (GCCT) could prevent allograft rejection in high-risk corneas. Design Prospective, randomized, comparative study. Methods settings: The Eye Hospital, Wenzhou Medical College, Zhejiang, China. study population: All patients with herpes simplex virus keratitis, bacterial keratitis, fungal keratitis, or ocular burn, who were eligible as per study design, were invited to participate. observation procedures: According to randomized block design, all patients received either GCCT or fresh corneal tissue (FCT) during DALK. Best-corrected visual acuity (BCVA), slit-lamp microscopy, and in vivo confocal microscopy examinations at 1 week and 1, 3, 6, 12, and 24 months after surgery were analyzed. Kaplan-Meier survival analysis was used to evaluate graft survival rate. main outcome measures: Therapeutic success, 2-year rejection-free graft survival rate and 2-year graft survival rate, in vivo confocal microscopy results, BCVA, and endothelial cell density. Results Postoperative BCVA of 20/40 or better at the last follow-up visit was achieved in 57.6% (19/33) of eyes in the GCCT group and in 54.8% (17/31) of the FCT group. No graft rejection occurred in the GCCT group, while in the FCT group 10 episodes of stromal rejection developed in 7 eyes. Overall, the rejection-free graft survival rate at 2 years was significantly higher in the GCCT group as compared with the FCT group (100.0%, 78.8% respectively, P = .006). Conclusions Deep anterior lamellar keratoplasty using acellular glycerol-preserved cornea could prevent allograft rejection and promote graft survival rate in high-risk corneas.