https://doi.org/10.31288/oftalmolzh20165313

Results of therapeutic keratoplasty using porcine keratoxenoimplant in severe destructive inflammations of the human cornea

G. I. Drozhzhina, Dr Sc (Med), Prof.

T. B. Gaidamaka, Dr Sc (Med)

E.V. Ivanovskaia, Cand Sc (Med)

V.L. Ostashevskii, Cand Sc (Med)

B.M. Kogan, Cand Sc (Med)

V.Ia. Usov, Dr Sc (Med)

N.V. Pasyechnikova, Dr. Sc. (Med), Prof

Filatov Institute of Eye Diseases and Tissue Therapy, NAMS of Ukraine

Odessa, Ukraine

E-mail: cornea@te.net.ua

 

Introduction. One of key methods of surgical treatment for patients with severe destructive inflammatory process (SDIP) of the cornea is keratoplasty. Being performed as an urgent intervention in SDIP of the cornea, keratoplasty is the only method to preserve the eye as an organ and, in some cases, to create prospects for optic surgery. The problem of donor material shortage is of a special relevance since the legal base providing donor material harvesting is incomplete and as a result of increased military, traffic and home traumatism. The acute shortage of donor material for keratoplasty (KP) forces searching new graft materials. One of such material is a porcine cornea which has many similarities with a human cornea in regard to its structure and biomechanical parameters.

Material and Methods. We retrospectively analyzed the outcomes of 32 patients with severe destructive corneal inflammatory diseases of various etiologies, who underwent therapeutic keratoplasty using cryolyophilized keratoxenoimplant of the porcine cornea at Corneal Pathology Department of the Filatov Institute from January 2013 to December 2015.

Results. As a result of treatment, the eye as an organ was preserved. Not transparent keratoxenoimplant survival was observed in late postoperative period. Of 37 patients, undergone lamellar or penetrating keratoplasty, keratoxenoimplant survival was semitransparent in 9 cases (33.3%) and opaque in 18 cases (66.7%). Biological dressing survived opaque in two cases; and in three cases it resolved within 2-8 weeks after operation. At late follow-up period after keratoxenotransplantation partial lysis of xenograft was noted in 7 eyes (21.9%); of them, repeat keratoplasty using donor human cornea was performed in 5 cases, single-stage glaucoma surgery was in one case, and single-stage cataract extraction in another one. In the late follow-up, glaucoma surgery was performed in 5 eyes (15.6%). As a result of xenotransplantation, visual acuity improved in 5 eyes (15.6%), did not change in 24 eyes (75%), and changed for the worse in 3 eyes (9.6%). In destructive processes of small diameter with paracentral and peripheral location, we could preserve and improve visual functions. Prospects for optic surgery performance were kept in 20 patients (62.5%).

Conclusion. Thus, under the urgent condition when donor human cornea is not available, keratoxenoimplant can be used for therapeutic keratoplasty in order to manage the inflammatory process and to preserve the eye.

Key words: destructive inflammatory corneal disease, therapeutic keratoplasty, keratoxenoimplant

 

References

1.Moroz ZI, Takhchidi KhP, Kalinnikov IuS. [Modern aspects of keratoplasty]. [Fyodorov Memorial Lectures. New technologies in the treatment of cornea pathology: Proceedings of All-Russian scientific and practical conference]. M.:2004. 280-4. Russian.

2.Lamm V, Hara H, Mammen A, Dhaliwal D, Cooper D. Сorneal blindness and xenotransplantation. Xenotransplantation. 2014; Mar 21(2):99–114.
Crossref   Pubmed

3.Rachwalik D, Pleyer U, Bakterielle Keratitis. Klin.Monatsbl.Augenheikd. 2015;232:  738-44.
Crossref   Pubmed

4.Ahn M, Yoon K, Ryu S et al. Clinical aspects and prognosis of mixed microbial keratitis. Cornea. 2011;30:409-13.
Crossref   Pubmed

5.Amescua G, Miller D, Alfonso E. What is causing the corneal ulcer? Management strategies for unresponsive corneal ulceration. Eye. 2012;26:228-36.
Crossref   Pubmed

6.Fleizig S, Evans D. Pathogenesis of contact lens – associated microbial keratitis. Optom. Vis. Sci. 2010;87:225-32.
Crossref   Pubmed

7.Volkovich TK, Korolkova NK, Khoroshenkaia NV. [Bacterial keratitis: etiology, pathogenesis]. Vestnik VGMU. 2011;10(3):5-10. Russian. 

8.Sitnik GV. [Modern approaches to the treatment of corneal ulcers]. Meditsinskii Zhurnal. 2011;4:100-4. Russian. 

9.Gurko VV, Fabrikantov. SK. [Penetrating keratoplasty in corneal perforation of different genesis]. Oftalmologiia. 2012;1[Pathology of the cornea and ocular surface]. Russian.  

10.Pierson R, Dorling A, Ayares D et al. Current status of xenotransplantation and prospects for clinical application. Xenotransplantation. 2009;16:263–80. 

11.Cooper D, Dorling A, Pierson R et al. Alpha1,3-galactosyltransferase gene-knockout pigs for xenotransplantation: where do we go from here?. Transplantation. 2007;84:1–7. 

12.Hara Н, Cooper D. Xenotransplantation – the future of corneal transplantation? Cornea. 2011; Apr 30 (4): 371–8.

13.Cooper D. The case for xenotransplantation. Clin Transplant. 2015;Apr 29(4):288-93.

14.Pasyechnikova NV, Iakymenko SA, Biguniak VV, Turchyn MV, Nasinnyk OI. [Clinical and experimental results of the use of amniotic membrane and cryolyophilized porcine cornea as materials for keratoplasty]. Med Syog Zavt. 2011;1-2:50-1. Ukrainian. 

15.Pasyechnikova NV, Iakymenko SA, Biguniak VV, Turchyn MV.  [Experimental substantiation and the first experience of clinical use of xenocornea in therapeutic-and-tectonic keratoplasty in patients with corneal ulcers of various etiologies]. Nov Med Farm. 2012;417:36-8. Ukrainian. 

16.Pasyechnikova NV, Turchyn MV,  Biguniak VV at al. Patent UA (11) 52278 Bioimplant 25.08.2010, Buk No.16, 2010.

17.Biguniak VV. [Preserved auto- and xenografts for restoration of lost skin cover of burned personsfrom the burnt]. Author’s thesis for Dr. of Med. Sc.;1995. Russian. 

18.Pasyechnikova NV, Turchyn MV,  Yakymenko SA. Patent UA (11) 60284 Method for assessing optical properties of bioimplant xenogenic cornea. 06.2011, Bul No. 11, 2011.

19.Pasyechnikova NV, Iakymenko SA, Turchyn MV, Buznyk OI, Kostenko PO. Use of keratoxenoimplant for therapeutic and therapeutic-and-tectonic keratoplasty in severe ocular burns and corneal ulcerations of various etiologies. J.ophthalmol.(Ukraine).2015;5:13-17.

20.Lee HI, Kim MK, Ko JH et al. The Characteristics of Porcine Cornea as a Xenograft. J Korean Ophthalmol Soc. 2006;47:2020–9.

21.Niederkorn JY. The immune privilege of corneal allografts. Transplantation. 1999;67:1503–8. 

22.Chong EM, Dana M. R. Graft failure IV. Immunologic mechanisms of corneal transplant rejection. Int Ophthalmol. 2008;28:209–22.

23.Tai HC, Ezzelarab M, Hara H et al. Progress in xenotransplantation following the introduction of gene-knockout technology. Transpl Int. 2007; 20:107–17. 

24.Qian Y, Dana MR. Molecular mechanisms of immunity in corneal allotransplantation and xenotransplantation. Expert Rev Mol Med. 2001;3:1–21. 

25.Cozzi E, White DJ. The generation of transgenic pigs as potential organ donors for humans. Nat Med. 1995;1:964–6.

26.Phelps CJ, Ball SF, Vaught TD et al. Production and characterization of transgenic pigs expressing porcine CTLA4-Ig. Xenotransplantation. 2009;16:477–85.

27.Oropeza M, Petersen B, Carnwath JW et al. Transgenic expression of the human A20 gene in cloned pigs provides protection against apoptotic and inflammatory stimuli. Xenotransplantation. 2009;16:522–34.