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Pierre Isard, Marielle Mentek, Thomas Dulaurent; Improvement of the water tightness of a monobloc keratoprosthesis with the use of a surgical bio-glue. Preliminary results in dogs. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3471.
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The mid- and long-term water tightness is a key point in the keratoprosthesis (KP) implantation procedure. Major complications such as athalamia and endophtalmitis may be linked to incomplete water tightness. The use of a surgical bio-glue may be a satisfactory solution to prevent the risk of aqueous humor leakage.
Patients: 5 dogs were presented for vision loss of corneal origin, secondary to an immune-mediated chronic superficial keratitis. Keratoprosthesis: KPro-LID® is a full thickness monobloc PMMA KP, with 4 retrocorneal fixation sites and without colonisable skirt. Surgical bio-glue: GRF® was originally manufactured for vascular surgery. It is composed of gelatin/resorcin (adhesive property) and formaldehyde/glutaraldehyde (hardening property). Surgical procedure: aAfter 6 months, no water-tightness defect was observed and no abnormal tissue reaction was identified, secondary to the use of GRF glue. 0.2 mm depth x 5.5 mm diameter superficial keratectomy was performed in the central cornea. Around the keratectomy site and at the same depth, the superficial cornea was undermined over 360°. The dissected cornea was cut over 300°, 2 mm in front of the limbus and parallel to it. The rim was reflected and a complete penetrating, 5.5 mm diameter central keratectomy was performed. After filling the anterior chamber with visco-material, the keratectomy was enlarged with a 3 mm full-thickness radial incision. The KP was implanted and anchored to the cornea by passing 4 U-shaped sutures through the retrocorneal fixation sites. The corneal radial incision was sutured and the GRF glue was applied over the uncovered corneal surface, up to the edge of the KP. The superficial rim was repositioned and the circular peripheral incision was sutured. The dogs were re-evaluated at 8 days, 15 days and then monthly for 6 months.
After 6 months, no water-tightness defect was observed and no abnormal tissue reaction was identified, secondary to the use of GRF glue.
The GRF glue improved the water-tightness of the KPro-LID in dogs. The ease of use and safety of this bio-glue make it an important step of the KP implantation surgical procedure.
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