Top

Published in:

Open Access 01-12-2017 | Research article

Comparison of femtosecond laser-assisted corneal intrastromal xenotransplantation and the allotransplantation in rhesus monkeys

Published in: BMC Ophthalmology | Issue 1/2017

Abstract

Background

In our previous study, we showed that both allogeneic and autogeneic small-incision femtosecond laser-assisted corneal intrastromal transplantation are safe and effective surgeries. However, the results of small-incision femtosecond laser-assisted intrastromal xenotransplantation have not yet been explored. Additionally, we suggest that glycerol-dehydrated corneal lamellae might provide a possible alternative for this xenogenic implantation approach.

Methods

Corneal inlay lamellae were produced from rabbits and humans using femtosecond laser-assisted surgeries and were dehydrated in glycerol for 1 week at 4 °C. These xenogeneic glycerol-dehydrated grafts and fresh allogeneic monkey lamellae were then implanted into rhesus monkeys using small-incision femtosecond laser assistance. Postoperatively, clinical examinations, AS-OCT measurements and tear inflammatory mediator assays were performed.

Results

There were no significant changes in the transparency of the corneal lamellae after glycerol dehydration. Following implantation, no evidence of tissue rejection or severe inflammatory responses was observed in the monkeys, and the host corneas remained transparent throughout a 6-month observation period. The grafts were clearly visible via AS-OCT. Corneal thickness increased 1 week postoperatively but subsequently declined and remained unchanged 1 month after surgery. Significant changes were observed in all tear inflammatory mediators in the ‘Rabbit to Monkey’ group. The trends in changes of tear inflammatory mediators in the ‘Human to Monkey’ group were similar to those in the ‘Rabbit to Monkey’ group. At 1 month post-surgery, the levels of most tear inflammatory mediators had decreased, with the exception of IL-1β, TGF-β1 and IFN-γ in the allotransplantation group.

Conclusion

Small-incision femtosecond laser-assisted intrastromal transplantation minimized invasiveness and improved surgical efficiency. In addition, the host cornea maintained a high level of biocompatibility. Glycerol-dehydrated corneal lamellae might be potentially useful as an alternative inlay xenogeneic material. In this study, we also describe a new treatment that can be used in keratoconus, corneal ectasia, presbyopia, hyperpresbyopia and other diseases.

Moffatt SL, Cartwright VA, Stumpf TH. Centennial review of corneal transplantation. Clin Exp Ophthalmol. 2005;33(6):642–57.CrossRefPubMed

Mamalis N, Anderson CW, Kreisler KR, Lundergan MK, Olson RJ. Changing trends in the indications for penetrating keratoplasty. Arch Ophthalmol. 1992;110(10):1409–11.CrossRefPubMed

Hanada K, Igarashi S, Muramatsu O, Yoshida A. Therapeutic keratoplasty for corneal perforation. Cornea. 2008;27(10):1219–20.CrossRefPubMed

Kanai A. The pathogenesis and treatment of corneal disorders. Nippon Ganka Gakkai Zasshi. 2002;106(12):757–76. discussion 777PubMed

Tan DT, Janardhanan P, Zhou H, Chan YH, Htoon HM, Ang LP, Lim LS. Penetrating keratoplasty in Asian eyes: the Singapore corneal transplant study. Ophthalmology. 2008;115(6):975–982.e971.CrossRefPubMed

Thompson RW, Price MO, Bowers PJ, Price FW. Long-term graft survival after penetrating keratoplasty. Ophthalmology. 2003;110(7):1396–402.CrossRefPubMed

Spadea L, De Rosa V. Current techniques of lamellar keratoplasty for keratoconus. Saudi Med J. 2016;37(2):127–36.CrossRefPubMedPubMedCentral

Wedner S, Dineen B. Refractive errors. Trop Dr. 2003;33(4):207–9.

Zhang YM, Wu SQ, Yao YF. Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus. J Zhejiang Univ Sci B. 2013;14(5):438–50.CrossRefPubMedPubMedCentral

10.

Barraquer JI. Keratophakia. Trans Ophthalmol Soc U K. 1972;92:499–516.PubMed

11.

Liu LP, Wang Y, He M, Li SQ, Zeng MZ, Zhong XW. Preliminary Investigation Femtosecond Laser-assisted Refractive Lenticule Transplantation in Rhesus Monkeys. Journal Of Sun Yat-sen University (Medical Sciences). 2015;36(3):449–55.

12.

Holzer MP, Rabsilber TM, Auffarth GU. Femtosecond laser-assisted corneal flap cuts: morphology, accuracy, and histopathology. Invest Ophthalmol Vis Sci. 2006;47(7):2828–31.CrossRefPubMed

13.

Yoo SH, Hurmeric V. Femtosecond laser-assisted keratoplasty. Am J Ophthalmol. 2011;151(2):189–91.CrossRefPubMed

14.

Feng Y, Wang W. In vivo confocal microscopic observation of lamellar corneal transplantation in the rabbit using xenogenic acellular corneal scaffolds as a substitute. Chin Med J. 2015;128(7):933–40.CrossRefPubMedPubMedCentral

15.

Fontana L, Errani PG, Zerbinati A, Musacchi Y, Di Pede B, Tassinari G. Frequency of positive donor rim cultures after penetrating keratoplasty using hypothermic and organ-cultured donor corneas. Cornea. 2007;26(5):552–6.CrossRefPubMed

16.

McNair JN, King JH. Preservation of cornea by dehydration; a preliminary report. AMA Arch Ophthalmol. 1954;53(4):519–21.CrossRefPubMed

17.

Chen W, Lin Y, Zhang X, Wang L, Liu M, Liu J, Ye Y, Sun L, Ma H, Qu J. Comparison of fresh corneal tissue versus glycerin-cryopreserved corneal tissue in deep anterior lamellar keratoplasty. Invest Ophthalmol Vis Sci. 2010;51(2):775–81.CrossRefPubMed

18.

Li J, Shi S, Zhang X, Ni S, Wang Y, Curcio CA, Chen W. Comparison of different methods of glycerol preservation for deep anterior lamellar keratoplasty eligible corneas. Invest Ophthalmol Vis Sci. 2012;53(9):5675–85.CrossRefPubMed

19.

Li J, Yu L, Deng Z, Wang L, Sun L, Ma H, Chen W: Deep anterior lamellar keratoplasty using acellular corneal tissue for prevention of allograft rejection in high-risk corneas. Am J Ophthalmol 2011, 152(5):762-770.e763.

20.

Davis FA. The anatomy and histology of the eye and orbit of the rabbit. Trans Am Ophthalmol Soc. 1929;27:400.402–41.

21.

Utine CA, Tzu JH, Akpek EK. Lamellar keratoplasty using gamma-irradiated corneal lenticules. Am J Ophthalmol. 2011;151(1):170–174.e171.CrossRefPubMed

22.

Tripathi H, Mehdi MU, Gupta D, Sen S, Kashyap S, Nag TC, Purwar M, Jassal M, Agrawal AK, Mohanty S, et al. Long-term preservation of donor corneas in glycerol for keratoplasty: exploring new protocols. Br J Ophthalmol. 2016;100(2):284–90.CrossRefPubMed

23.

King JH. Keratoplasty; experimental studies with corneas preserved by dehydration. Trans Am Ophthalmol Soc. 1956;54:567–609.PubMedPubMedCentral

24.

King JH, McTigue JW, Meryman HT. A simple method of preservation of corneas for lamellar keratoplasty. Am J Ophthalmol. 1962;53:445–9.CrossRefPubMed

25.

Boynton GE, Woodward MA. Evolving Techniques in Corneal Transplantation. Curr Surg Rep. 2015;3(2). https://doi.org/10.1007/s40137-014-0079-5.

26.

Bednarz J, Doubilei V, Wollnik PC, Engelmann K. Effect of three different media on serum free culture of donor corneas and isolated human corneal endothelial cells. Br J Ophthalmol. 2001;85(12):1416–20.CrossRefPubMedPubMedCentral

27.

Stonecipher K, Ignacio TS, Stonecipher M. Advances in refractive surgery: microkeratome and femtosecond laser flap creation in relation to safety, efficacy, predictability, and biomechanical stability. Curr Opin Ophthalmol. 2006;17(4):368–72.CrossRefPubMed

28.

Blum M, Täubig K, Gruhn C, Sekundo W, Kunert KS. Five-year results of small incision Lenticule extraction (ReLEx SMILE). Br J Ophthalmol. 2016;

29.

Dana MR, Qian Y, Hamrah P. Twenty-five-year panorama of corneal immunology: emerging concepts in the immunopathogenesis of microbial keratitis, peripheral ulcerative keratitis, and corneal transplant rejection. Cornea. 2000;19(5):625–43.CrossRefPubMed

30.

Netto MV, Mohan RR, Medeiros FW, Dupps WJ, Sinha S, Krueger RR, Stapleton WM, Rayborn M, Suto C, Wilson SE. Femtosecond laser and microkeratome corneal flaps: comparison of stromal wound healing and inflammation. J Refract Surg. 2007;23(7):667–76.PubMedPubMedCentral

31.

O'Brien TP, Li Q, Ashraf MF, Matteson DM, Stark WJ, Chan CC. Inflammatory response in the early stages of wound healing after excimer laser keratectomy. Arch Ophthalmol. 1998;116(11):1470–4.CrossRefPubMed

32.

Bian F, Barbosa FL, Corrales RM, Pelegrino FS, Volpe EA, Pflugfelder SC, de Paiva CS. Altered balance of interleukin-13/interferon-gamma contributes to lacrimal gland destruction and secretory dysfunction in CD25 knockout model of Sjögren's syndrome. Arthritis Res Ther. 2015;17:53.CrossRefPubMedPubMedCentral

33.

De Paiva CS, Chotikavanich S, Pangelinan SB, Pitcher JD, Fang B, Zheng X, Ma P, Farley WJ, Siemasko KF, Niederkorn JY, et al. IL-17 disrupts corneal barrier following desiccating stress. Mucosal Immunol. 2009;2(3):243–53.CrossRefPubMedPubMedCentral

34.

Ebihara N, Matsuda A, Nakamura S, Matsuda H, Murakami A. Role of the IL-6 classic- and trans-signaling pathways in corneal sterile inflammation and wound healing. Invest Ophthalmol Vis Sci. 2011;52(12):8549–57.CrossRefPubMed

35.

Joo CK, Seomun Y. Matrix metalloproteinase (MMP) and TGF beta 1-stimulated cell migration in skin and cornea wound healing. Cell Adhes Migr. 2008;2(4):252–3.CrossRef

36.

Haber M, Cao Z, Panjwani N, Bedenice D, Li WW, Provost PJ. Effects of growth factors (EGF, PDGF-BB and TGF-beta 1) on cultured equine epithelial cells and keratocytes: implications for wound healing. Vet Ophthalmol. 2003;6(3):211–7.CrossRefPubMed

37.

Zhang C, Ding H, He M, Liu L, Li G, Niu B, Zhong X. Comparison of early changes in ocular surface and inflammatory mediators between Femtosecond Lenticule extraction and small-incision Lenticule extraction. PLoS One. 2016;11(3):e0149503.CrossRefPubMedPubMedCentral

38.

Ganesh S, Brar S, Patel U. Comparison of ReLEx SMILE and PRK in terms of visual and refractive outcomes for the correction of low myopia. Int Ophthalmol; 2017. https://doi.org/10.1007/s10792-017-0575-6.

39.

Okada Y, Ikeda K, Yamanaka O, Miyamoto T, Kitano A, Kao WW, Saika S. TNFalpha suppression of corneal epithelium migration. Mol Vis. 2007;13:1428–35.PubMed

40.

King WJ, Comer RM, Hudde T, Larkin DF, George AJ. Cytokine and chemokine expression kinetics after corneal transplantation. Transplantation. 2000;70(8):1225–33.CrossRefPubMed

41.

Boisgérault F, Liu Y, Anosova N, Dana R, Benichou G. Differential roles of direct and indirect allorecognition pathways in the rejection of skin and corneal transplants. Transplantation. 2009;87(1):16–23.CrossRefPubMedPubMedCentral

42.

Afzali B, Lombardi G, Lechler RI, Lord GM. The role of T helper 17 (Th17) and regulatory T cells (Treg) in human organ transplantation and autoimmune disease. Clin Exp Immunol. 2007;148(1):32–46.CrossRefPubMedPubMedCentral

Title: Comparison of femtosecond laser-assisted corneal intrastromal xenotransplantation and the allotransplantation in rhesus monkeys
Publication date: 01-12-2017
Published in: BMC Ophthalmology / Issue 1/2017
Electronic ISSN: 1471-2415
DOI: https://doi.org/10.1186/s12886-017-0595-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Comparison of femtosecond laser-assisted corneal intrastromal xenotransplantation and the allotransplantation in rhesus monkeys

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

Acute uveal effusion during phacoemulsification with preoperative central serous chorioretinopathy: a case report

The risk of cataractogenesis after gamma knife radiosurgery: a nationwide population based case-control study

Absolute and estimated values of macular pigment optical density in young and aged Asian participants with or without age-related macular degeneration

Incidental branch retinal artery occlusion on optical coherence tomography angiography presenting as segmental optic atrophy in a child: a case report

Long noncoding RNA expression profile in HLE B-3 cells during TGF-β2-induced epithelial-mesenchymal transition

Intraoperative optical coherence tomography assisted analysis of pars Plana vitrectomy for retinal detachment in morning glory syndrome: a case report