May 2004
Volume 45, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2004
Eccentric lamellar keratolimbal grafts harvested with a manual guided microkeratome
Author Affiliations & Notes
  • M. Grueterich
    Ophthalmology, University Eye Hospital LMU, Munich, Germany
  • K. Kenyon
    Cornea Consultants International, Boston, MA
  • C. Lackerbauer
    Ophthalmology, University Eye Hospital LMU, Munich, Germany
  • C. Kojetinski
    Ophthalmology, University Eye Hospital LMU, Munich, Germany
  • A. Kampik
    Ophthalmology, University Eye Hospital LMU, Munich, Germany
  • Footnotes
    Commercial Relationships  M. Grueterich, None; K. Kenyon, None; C. Lackerbauer, None; C. Kojetinski, None; A. Kampik, None.
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 3939. doi:
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      M. Grueterich, K. Kenyon, C. Lackerbauer, C. Kojetinski, A. Kampik; Eccentric lamellar keratolimbal grafts harvested with a manual guided microkeratome . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3939.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Abstract: : Purpose: The causal therapy for limbal stem cell deficiency (LSD) is limbal stem cell transplantation. Often additional stromal scarring requires subsequent corneal transplantation. However our clinical experience shows that in most cases stromal alterations do not require full thickness corneal grafts but could also be handled by lamellar transplantation.Additionally we were able to show that simultaneous limbal and penetrating corneal transplantation has a poor prognosis (Solomon et al 2002). Lamellar corneal grafts do not show allograft rejection which subsequently could harm the previous limbal allograft. In a first step to perform lamellar keratolimbal allograft transplantation in a one step procedure with a single graft, we investigated the option of harvesting eccentric lamellar keratolimbal allografts using a manual guided microkeratone. Methods: We used the Moria–LSK–One microkeratome (Antony, France) with three microkeratome heads precalibrated for 100, 200 and 350 micron cutting depth. 10 human donor eyes were used to obtain single piece lamellar keratolimbal grafts. Specimen were processed for light– and electronmicroscopy. Results: Graft diameters of up to 10mm were obtained by either using the microkeratome on a whole donor eye or with an artificial anterior chamber provided by Moria for automated lamellar therapeutic keratoplasty (ALTK). With all three microkeratome heads we were able to obtain eccentric keratolimbal grafts which include central cornea as well as limbal tissue. Morphological analysis shows regular limbal and corneal epithelial structures with no visible damage to the limbal region. The stromal plane and the cutting edges were smooth and did not show significant irregularities. Conclusions: We believe that eccentric lamella keratolimbal allograft transplantation could be a therapeutic option for ocular surface reconstruction in situations where LSD is associated with superficial and midstromal corneal scarring. Moreover the LSK–One in conjunction with the artificial anterior chamber seem to allow individual adaptation of the graft to the corneal pathology. If the donor bed is prepared in the same manner, excellent apposition of the graft and the recipient can be expected which in turns is a prerequisite for optimal wound healing conditions.

Keywords: cornea: clinical science • cornea: epithelium • transplantation 
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