Eye preservation tectonic graft using glycerol-preserved donor cornea

Abstract

Aims To report the surgical outcome of tectonic graft using glycerol-preserved donor corneas to treat perforated keratitis. Methods The medical records were reviewed of all patients treated for perforated keratitis using glycerol-preserved corneas at a single institution between 1 July 2004 and 31 June 2010. The clinical features, precipitating factors, adjuvant therapies, and therapeutic outcomes were analyzed. Success was defined as re-epithelialization of the ocular surface without evisceration. Results Fourteen eyes from 14 patients (6 male and 8 female) were included. Age ranged from 58 to 84 years (average, 70.71±8.52 years) and the follow-up time ranged from 7 to 56 months (mean, 25.35 ± 16.84 months). The culture results showed five bacterial infections, five cases of fungal keratitis, and one mixed infection; the culture results were negative for three patients. Satisfactory anatomical integrity was obtained in eight grafts (57.14%) that healed with neovascularization. Six grafts (48.85%) showed delayed re-epithelialization and were repaired with conjunctival flaps to maintain ocular surface integrity. Three patients developed secondary glaucoma and received trans-scleral cyclophotocoagulation. Thirteen patients had satisfactory anatomical integrity without evisceration or exenteration, while one patient received evisceration at 39-month follow-up because of intractable glaucoma. Conclusions Glycerol-preserved donor corneas combined with anterior vitrectomy with or without conjunctival flaps may be effective substitutes for evisceration surgery in patients with perforated keratitis.

Use of glycerol-preserved corneas for corneal transplants

“…Lin et al . [ 11 ] demonstrated good cosmetic results utilizing GPC for tectonic keratoplasty with anterior vitrectomy with/without conjunctival flaps as an adequate substitute for evisceration in patients with perforated keratitis. All the patients in their study had little or no visual potential.…”

“…Glycerol preservation is a simple technique of long-term storage of acellular corneal tissue, and one of the major benefits of this method is the fact that corneal tissue can be safely preserved up to 5 years after harvesting. [ 11 ] GPC has no viable endothelium and can be used for lamellar corneal transplant that does not require high-quality tissue. GPC can be used in emergencies like perforated corneal ulcer or globe rupture to maintain the globe integrity by therapeutic or tectonic keratoplasty.…”

Long-term preservation of donor corneas in glycerol for keratoplasty: exploring new protocols

“…In addition to all other advantages, glycerol-preserved corneas substantially decreases the cellularity15 and antigenicity of corneal tissues hence minimising any immune rejection12 13 as cells like keratocytes, epithelial cells and other bone-marrow-derived cells are important targets for any allograft response. Various reports have been published delineating that glycerol-preserved donor corneas may be effective substitutes for fresh corneas in patch grafts16 perforated ulcers,17 infectious keratitis,18 eccentric peripheral grafts,19 full-thickness tectonic grafts,20 therapeutic PK3 and to repair exposed glaucoma drainage implants 21. The study by Chen et al concluded that DALK using glycerine-cryopreserved corneal tissue provides clinical results comparable with fresh cornea 13…”

Eckardt Keratoprosthesis for Tectonic Repair of a Large Corneal Perforation

“…In the developing countries, glycerin-preserved donor corneas are occasionally grafted for emergent tectonic penetrating keratoplasty. 5 The advantages include lower cost, a lower rate of rejection, and a lower rate of postoperative infections when compared with fresh corneas; the disadvantages to deal with include opacification after reepithelialization, poor visual outcome, and suboptimal esthetic outcomes.…”