Preimplantation dehydration for corneal allogenic intrastromal ring segment implantation

Parker, Jack; Dockery, Philip W.; Jacob, Soosan; Parker, John S.

doi:10.1097/j.jcrs.0000000000000582

Cited by 16 publications

(16 citation statements)

References 5 publications

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“…In addition, it prolongs the time of a procedure that is notoriously fast when synthetic segments are used. Parker et al 3 suggested partial dehydration of large segments to reduce their thickness and facilitate their introduction into the stromal tunnel. Although this technique is quite helpful in facilitating CAIRS insertion, it is different than ours because the segments were still described to be soft and nonrigid, and the surgical video accompanying the published technique shows that the allogenic segment is still flaccid and had to be shoved into the tunnels using a Y-rod instrument.…”

Section: Discussionmentioning

confidence: 99%

Extended Dehydration of Corneal Allogenic Intrastromal Ring Segments to Facilitate Insertion: The Corneal Jerky Technique

Awwad,

Jacob,

Assaf

et al. 2023

Cornea

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Purpose: The aim of this study was to describe a new technique to facilitate the insertion of corneal allogenic intrastromal ring segments. Methods: A single-segment corneal allogenic intrastromal ring segment (CAIRS) was trephined from donor corneas and allowed to markedly dehydrate for 75 minutes before the start of the procedure with a room humidity of 35% to 45%. The duration of the insertion step and the intrastromal segment size at 1 week as measured by optical coherence tomography were compared with previously performed single-segment CAIRS procedures using the conventional technique. Results: A total of 41 eyes of 36 patients underwent 1-segment CAIRS insertion of the same trephination size (750 µm). Fifteen eyes underwent the conventional insertion procedure, and 26 eyes had a dehydrated segment inserted. The time taken to insert the CAIRS analyzed by surgical video recording starting after the femtosecond tunnel creation and initiation of the insertion to the segment ironing step was 282 ± 103 and 97 ± 23 seconds for the conventional and the dehydrated segment technique, respectively (P < 0.001). Anterior segment optical coherence tomography performed 1 week postoperatively revealed similar segment thickness and width of 471.3 ± 54.1 μm and 1285.1 ± 191.0 μm for the conventional allogenic segments and 483.4 ± 58.3 μm and 1227.2 ± 165.2 μm for the dehydrated segments (P = 0.515 and 0.314, respectively). Conclusions: Markedly dehydrated corneal allogenic segments are easier and faster to insert than the nondehydrated ones while maintaining similar sizes intrastromally. This dehydration technique makes the procedure similar to the one with synthetic segments and hence reduces the learning curve.

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Section: Discussionmentioning

confidence: 99%

Extended Dehydration of Corneal Allogenic Intrastromal Ring Segments to Facilitate Insertion: The Corneal Jerky Technique

Awwad,

Jacob,

Assaf

et al. 2023

Cornea

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“…2 The segments are then rinsed with saline and placed on a dry surgical sponge, while the recipient eye is prepared. 3…”

Section: Surgical Techniquementioning

confidence: 99%

“…2 The segments are then rinsed with saline and placed on a dry surgical sponge, while the recipient eye is prepared. 3 Under general anesthesia, a handheld pachymeter (PachPen, Accutome, Inc.,) measures corneal thickness at the primary incision, 2.0 mm inside the temporal limbus. An epithelial impression is created using an 11.0 mm Zone Marker (Duckworth & Kent Ltd.), the center of which is dotted using an inked Sinskey hook to define the pupillary axis.…”

Section: Surgical Techniquementioning

confidence: 99%

Flattening the curve: manual method for corneal allogenic intrastromal ring segment implantation

Parker

Dockery

Parker

2021

J Cataract Refract Surg

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Corneal allogenic ring segments are semicircular pieces of donor corneal stroma that may be surgically implanted to flatten keratoconic corneas. Conventionally, these donor segments are inserted into channels created using femtosecond laser dissection. However, access to femtosecond technology is not universal. In this study, an alternate, manual technique for channel creation, which is femtosecond laser independent, is described.

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“…The best-corrected visual acuity (BCVA) in mild–moderate stages may be managed with intrastromal corneal ring segments (ICRS) [ 4 ] to achieve corneal flattening; however, this does not stop disease progression for most patients. Recently, there has been a wave of interest in other corneal inlay procedures, such as Bowman Layer transplantation (BL) and corneal allogenic intrastromal ring segments (CAIRS) [ 5 ]. In late-stage KC, corneal transplantation (deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP)) [ 6 ] becomes the only option for visual rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Collagen Crosslinking for Keratoconus: Cellular Signaling Mechanisms

et al. 2023

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Collagen crosslinking (CXL) is a widely used treatment to halt the progression of keratoconus (KC). Unfortunately, a significant number of patients with progressive KC will not qualify for CXL, including those with corneas thinner than 400 µm. The present study aimed to investigate the molecular effects of CXL using in vitro models, mirroring the normal, as well as thinner corneal stroma seen in KCs. Primary human corneal stromal cells were isolated from healthy (HCFs) and keratoconus (HKCs) donors. Cells were cultured and stimulated with stable Vitamin C resulting in 3D self-assembled extracellular matrix (ECM), cell-embedded, constructs. CXL was performed on (a) thin ECM with CXL performed at week 2 and (b) normal ECM with CXL performed at week 4. Constructs without CXL served as controls. All constructs were processed for protein analysis. The results showed modulation of Wnt signaling, following CXL treatment, as measured by the protein levels of Wnt7b and Wnt10a, correlated to the expression of α-smooth muscle actin (SMA). Further, the expression of a recently identified KC biomarker candidate, prolactin-induced protein (PIP), was positively impacted by CXL in HKCs. CXL-driven upregulation of PGC-1 and the downregulation of SRC and Cyclin D1 in HKCs were also noted. Although the cellular/molecular impacts of CXL are largely understudied, our studies provide an approximation to the complex mechanisms of KC and CXL. Further studies are warranted to determine factors influencing CXL outcomes.

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Preimplantation dehydration for corneal allogenic intrastromal ring segment implantation

Cited by 16 publications

References 5 publications

Extended Dehydration of Corneal Allogenic Intrastromal Ring Segments to Facilitate Insertion: The Corneal Jerky Technique

Extended Dehydration of Corneal Allogenic Intrastromal Ring Segments to Facilitate Insertion: The Corneal Jerky Technique

Flattening the curve: manual method for corneal allogenic intrastromal ring segment implantation

Collagen Crosslinking for Keratoconus: Cellular Signaling Mechanisms

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