Posters

A comparative trial on cross-linking of donor corneas to resist infections and melts in Boston type-1 keratoprosthesis

Poster Details

First Author: L.Daniel Ponniah INDIA

Co Author(s):    H. Anandan                    

Abstract Details

Purpose:

To compare the long term efficacy of cross-linking of donor corneas in resisting postoperative infections and corneal melt in Boston Type 1 Keratoprosthesis in eyes with multiple failed corneal grafts.

Setting:

A Prospective non-randomized comparative clinical trial at the Department of Corneal Transplantation, Dr.Agarwals Eye Hospitals, Tirunelveli, S. India.

Methods:

In the study group, de-epithelialized donor cornea underwent epi-off CXL with riboflavin and UVA (Dresden protocol). Cross-linked donor cornea acted as a carrier for Boston Type 1 keratoprosthesis.  We transplanted the crosslinked corneas in eyes with multiple failed corneal grafts with or without OSD.  In the control group, donor cornea was used without crosslinking. All subjects were on postoperative topical quinolone therapy and followed up for corneal integrity to resist infection and corneal melt at 5 years.

Results:

Mean follow up was 69+5.9 months in study group (n=16) and 64.83+ 4.0 months in control group (n=15).VA improved significantly from 1.98 to 0.89 in study group & 1.82 to 0.95 in control. Study group had not shown any infections or melt till 5th year. 2 eyes(13.3%) in control group had melts (18 & 36 months) and treated with subconjunctival steroids. 2 eyes(13.3%) in control group had infections (22 & 6 months, one underwent therapeutic keratoplasty and other progressed to endophthalmitis). Cross-linked corneas fight against the proteolytic enzymatic degradation resulting in inflamatory melt or a toxin associated infection.

Conclusions:

Cross-linking of donor cornea is found to be effective in improving long term postoperative strength, resists infections, and reduces keratolysis and melts in Boston Type 1 prosthokeratoplasty especially in cases with ocular surface disorders. This novel “Better together” concept is a promise in future, and donor corneal CXL could be an integral part of all Boston type 1 Kpro surgeries.

Financial Disclosure:

None