keratoplasty overview
TRANSCRIPT
An Overview on Keratoplasty
Dr Geetha K V
Changing trends in keratoplasty Mythology
Saint Lucy 283-304 AD Patron saint in
ophthalmology
Theories
130-200AD
• Galen• Abrasio cor’naea
1789 1796
• Guillaume Pellier de Quengsy- transparent material can restore vision
• Erasmus Darwin- proposed 1st trephine and postulated transparent scar
1817
• Establishment of Ophthalmology as the 1st surgical s subspecialty and foundation of Moorfields Eye Hospital, London.
Practice
18131818
1835
1838
1867
1888
• Karl Himley- advocated use of animal cornea
• Franz Reisinger (his student)- applied it, termed Keratoplasty• Samuel Bigger (Irish Surgeon)- 1st successful penetrating allograft in a pet gazelle
• Richard Kisam performed the 1sttherapeutic corneal xenograft on a human eye
• Henry Power(England) penetrating keratoplasty with allograft
• Arthur Von Hippel- Lamellar xenografts, invented clockwork trephine
Mark of Modern Era 1905- Edward Zirm
performed the 1st successful human allograft
Recommended1. Exclusive use of human
corneas2. Use of Von Hippel trephine3. Deep anaesthesia4. Asepsis5. Overlay sutures6. AC maintainer use7. Avoid touching tissue8. Place graft in moist gauze
Elschnig
1930
suggests cadeveric tissue use
Ramon Castroviejo
1932Invented instruments, circular grafts, direct
sutures
Vladimir Filatov
1931popularised
cadeveric tissue use
Various landmarks 1957 early use of corticosteroids in animal models of corneal
transplant
1952 Stocker notes importance of endothelium in corneal hydration
1953 Zeiss introduces 1st commercially available operating microscope
1960 Mackenson and Harms introduced ophthalmic nylon sutures
1968 Ethicon develops 10/0 nylon specifically for keratoplasty
1980 10 year success all over world of PKP for keratoconus recorded to be >90%
Leading to…
1. Eye bank establishment
2. EK and its modifications
3. ALK and its modifications
4. Kerato prosthesis
Eye Bank Development
1931• Vladimir Filatov (Russian)• Use of cadaver corneas
1944• Richard Paton (American)• Established 1st eye bank in New York
1955• Committee of eye banks was formed• Representing 12 eye banks all over USA
1961• Committee renamed as Eye Bank Association of
America (EBAA) and it established various training programs for technicians
Endothelial Keratoplasty and its modifications
1999
Mark Terry Modified PLK to DLEK
1998Gerrit Melles PLK, air bubble for
self adhesion
1956Charles Tillet 1st endothelial
keratoplasty
2006
Gerrit Melles DMEK technique introduction
2005Mark Gorovoy
Renamed DSEK to DSAEK after
introduction of microkeratome
2004Gerrit Melles
Modified DLEK to DSEK with
descematorrhexis
ALK and its modifications 1970
• Malbran and gasset were performing DALK
1985• Archila modified DALK, used air to separate corneal
layers
1989, 1992• Price, Chan
• Reported on DALK and said more refinement was required
2002• Anwar and Teichmann introduced ‘big bubble’
pneumodissection technique for DALK
FLAK- Femtosecond Laser Assisted Keratoplasty Femtosecond lasers: evolution
of keratoplasty would not be complete without a mention of this. to perform accurate corneal trephination for donor and recipients.
It is being used to begin trephination at a predetermined depth individualized for patients cornea
Has provided the flexibility to create shaped grafts that allow exact matches between donor and recipient, thus necessitating fewer sutures.
Customized trephination patterns with femtosecond laser-enabled keratoplasty. A, Standard ''butt-joint''B, ''top-hat''C, ''mushroom''D, ''zig-zag''E, ''Christmas tree.''
Keratoprosthesis Keratoprosthesis, the
transplantation of an artificial cornea, was first performed in Italy by Benedetto Strampelli the 1960s
Historical options have included the osteoodontokeratoprosthesis (OOKP) and AlphaCor artificial cornea. These have since been largely replaced by the Boston Type I Keratoprosthesis (KPro), which became approved for use by the U.S. Food and Drug Administration in 1992
Summary
Recent AdvancesBioengineered Corneas
Human Corneal Endothelial cell culture
In 2015, the world's first artificial bioengineered cornea was approved by CFDA( chinese FDA) to be applied clinically as a substitute for human cornea in lamellar keratoplasty.
‘ACORNEA’ is made using tissue engineering technique on porcine cornea to preserve collagen architecture of the corneal matrix so that it can quickly integrate with patients' corneal tissue. The transplanted cornea will gradually become transparent, thus leading to a recovery of patients' vision.
The new endothelial cell growth method developed by schepens eye research institute in masachussets, uses an agent that interrupts cell-to-cell contact. In addition, the medium contains growth factors that promote the proliferation of corneal endothelial cells.
may be implanted either as a monolayer or by injection into the anterior Chamber in future as a replacemenr or as an additive to keratoplasty
Thank You