Effect of diameter and depth on the response to solid polysulfone intracorneal lenses in cats

Confocal and Histological Features After Poly(Ethylene Glycol) Diacrylate Corneal Inlay Implantation

Purpose

To evaluate the in vivo biocompatibility of photopolymerized poly(ethylene glycol) diacrylate (PEGDA) intrastromal inlays in rabbit corneas.

Methods

Sixty-three eyes of 42 New Zealand rabbits were included. Manual intrastromal pockets were dissected in 42 eyes. PEGDA inlays were obtained using a specifically designed photomask and were inserted in the intrastromal pocket of 21 eyes (inlay group); the remaining 21 right eyes did not receive any implant (pocket-only group). Twenty-one eyes with no intervention were used as controls. In vivo confocal microscopy (IVCM) was performed at every visit. After 2 months, rabbits were sacrificed and corneas removed for histological analysis.

Results

Corneas remained clear in all but two animals, and five cases of corneal neovascularization were seen (P = 0.2). Inlays remained stable without evidence of lateral or anterior migration, and no other complications were observed. No changes in anterior and posterior keratocyte density (P = 0.3 and P = 0.1, respectively) or endothelial cell density (P = 0.23) were observed between groups during the study time by IVCM. On pathology samples, thinning of the epithelium over the inlay area and epithelial hyperplasia over the edges were observed. A polygonal empty space with no evidence of PEGDA hydrogel within the midstroma was seen in the inlay group. Keratocytes were normal in shape and number in the vicinity of the PEGDA implant area.

Conclusions

Photopolymerized PEGDA intrastromal inlays have shown relatively good safety and stability in rabbit corneas. Inlays were biostable in the corneal environment and remained transparent during follow up.

Translational Relevance

The investigated PEGDA is promising for the development of biocompatible intrastromal implants.

Intracorneal Inlays for the Correction of Ametropias

Various materials have been placed in the corneal stroma to modify a spherical refractive error (usually hyperopic). As the surgical procedures evolved to simplify the insertion process so has the quality and biocompatibility of the implanted materials. Failures have been due to excessive inlay dimensions, bioincompatibility of the materials used, poor choice of test model, or combinations of the above. We present a thorough analysis of the history of the intracorneal inlay and the materials and techniques used up to and including the current materials and techniques available for the correction of spherical refractive errors.

Outcomes of PermaVision intracorneal implants for the correction of hyperopia

PURPOSE

To report the clinical and visual outcomes of a series of patients implanted with the PermaVision intracorneal lens (ReVision Optics Inc, Lake Forest, California, USA) for correction of hyperopia.

DESIGN

Prospective, nonrandomized, clinical trial study.

METHODS

Fifteen patients were implanted with the intracorneal lens for correction of spherical hyperopic refractive errors ranging from 1.00 to 5.00 diopters (D) (mean, 2.45 D). All eyes were correctable to 20/20 before surgery. Patients were followed up to 3 years with measurements of residual refractive error, uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA).

RESULTS

For patients with follow-up of 1 year or more, the mean logarithm of the minimum angle of resolution BSCVA was 0.15 (20/28 Snellen equivalent; range, 0.1 to 0.6) with an average change of -2.5 lines of BSCVA (range, 1 to -6 lines). Only 3 eyes (25%) achieved 20/20 or better UCVA. Two patients experienced early adverse events and 1 patient experienced a late-onset adverse event requiring eventual removal of the implant. Nine patients elected to have the implant removed, with dissatisfaction with the quality of vision as the most frequent reason for removal.

CONCLUSIONS

The quality of visual and refractive outcomes with this device was less than satisfactory for most of the patients in our series. Although the problems of early onset migration or extrusion of the device are possible, late-onset ulceration noted in one of our patients most likely represents a neurotropic melt. Further research to improve the safety and quality of refractive result with intracorneal implants is needed.

Polymer design for corneal epithelial tissue adhesion: pore density

A porous polymer is required to sustain corneal epithelial tissue on the anterior surface of an implantable contact lens (corneal onlay). Porosity creates topography on the polymer surface and, if defined, this can be manipulated to elicit a particular tissue response. Previous work identified pores of 100-nm diameter to be the critical size of a discontinuity in a polymer surface to facilitate the migration, stratification, and sustained adhesion of corneal epithelial tissue. Now we address the issue of pore density. Corneal epithelial tissue was grown for 21 days on nonporous polycarbonate and polycarbonate track-etched with pores 100-nm diameter with pore densities ranging from 0.27 and 14.4% of the total polymer surface area. Histology was used to score epithelial structure, and electron microscopy was used to quantitate the formation of adhesive structures (basal lamina and hemidesmosomes) at the tissue-polymer interface. Data showed that epithelial tissue stratified and epithelial adhesive structures formed on polycarbonate surfaces with pore densities between 0.52 and 14.4% inclusive. This means that epithelial tissue can be maintained on a polymer where up to 14.4% of the surface is dedicated to small discontinuities in the form of pores 100-nm diameter. These figures can be used to specify the design of a polymer for applications requiring epithelial cover.

Wound Healing Following Intrastromal Photorefractive Keratectomy With the Nd:YLF Picosecond Laser in the Cat

BACKGROUND

We studied the histopathology of the stromal wound healing response in the cat cornea following intrastromal photorefractive keratectomy (IPRK) with the Nd:YLF picosecond laser.

METHODS

Intrastromal PRK was performed in the anterior stroma of cat corneas with the Nd:YLF picosecond laser. The cats were sacrificed at predetermined intervals ranging from immediately to 6 months postoperatively. Effects of the laser treatment on the epithelium, Bowman's layer, stroma, and the endothelium were evaluated using light and scanning electron microscopy. No anti-inflammatory agents were used.

RESULTS

Intrastromal PRK resulted in no perceptible damage to the corneal epithelium or Bowman's layer either acutely or at 6 months. The corneal stroma showed multiple cavitations immediately after intrastromal PRK, which collapsed over several hours, followed by thinning of the cornea over 2 weeks. At 1 month, the stromal collagen was abnormal with surrounding hypercellularity. The endothelium showed no injury, acutely or at 6 months. No thermal effects on stromal collagen were observed at 6 months, and disruption of the lamellar pattern was not apparent after the cavitation bubbles were reabsorbed.

CONCLUSION

Intrastromal PRK can effectively remove stromal tissue without acute damage to the adjacent lamellae, epithelium, or endothelium. There is a transient cellular wound healing response associated with a transient stromal collagen abnormality at 2 weeks to 1 month, which was not apparent 2 months after the procedure.

Tissue reactions induced by modified poly(vinyl alcohol) hydrogels in rabbit cornea

The purpose of this study was to compare the tissue reactions induced by modified poly(vinyl alcohol) (PVA) hydrogels with other materials implanted in the rabbit cornea. PVA hydrogels with and without covalently bonded collagen were compared to ethylene-vinyl alcohol copolymer, and polysulfone discs. These materials were implanted in the rabbit corneal stroma. The resultant tissue reactions were histologically and clinically studied. The PVA hydrogels had high flux rates of glucose and L-lactic acid in vitro. Covalent immobilization of collagen onto their surface was found to render them more biocompatible. However, excessive ulceration and vascularization of the cornea still occurred in vivo, possibly because of extremely little blinking of the rabbits, which might cause desiccation of the cornea.

Gel injection adjustable keratoplasty

Gel injection adjustable keratoplasty (GIAK) is a new refractive surgical procedure designed for the correction of myopia by injection of a gel substance into the peripheral corneal stroma. This paper describes the GIAK technique and reports the results obtained in 21 fresh cadaveric eyes using the procedure. After a deep interlamellar canal has been dissected with a helicoid spatula surrounding the visual axis, the gel is injected under keratometric control. In the 1st group of 14 eyes, the degree of correction varied from 2.2 to 12.8 D; there was a direct relationship between the amount of gel injected and the keratometric change. In the 2nd group of 7 eyes, the adjustability of the procedure was demonstrated. Through partial extraction of the gel and subsequent modification of the corneal curvature, the previously induced keratometric changes could be reversed or altered to a specific extent. Following the initial injection of gel to a targeted flattest meridian power of 35 D, an average value of 35.8 +/- 0.5 D was achieved in these eyes. We subsequently attempted to increase the flattest meridian to 40 D by partial removal of the gel and achieved a mean value of 40.2 +/- 0.4 D. Average presurgical astigmatism of 1.497 +/- 0.737 D was reduced to a postsurgical reading of 0.941 +/- 0.590 D (P = 0.005, Student's paired t-test), indicating an autocorrection by autodistribution of the gel inside the canaliculus (Laplace's law). GIAK is a simple, inexpensive procedure designed for the correction of myopia that has the added advantage of reducing preexisting astigmatism without encroaching on the visual axis.

Modeling glucose distribution in the cornea

The central cornea obtains its glucose by diffusion through the cornea from the aqueous humor to the epithelium. The diffusion of glucose in the cornea is analogous to the flow of current in an electrical resistance network. The cellular consumption of glucose can be compared to shunting a portion of the charge to electrical ground. An electrical analog model of the cornea was developed to predict the availability of glucose to the epithelium and the distribution of glucose in the stroma. The glucose constant concentration lines in the normal stroma are parallel to the corneal surface and have decreasing values from 880 to 580 micrograms/ml. The effects on epithelial glucose concentration by implanting an intracorneal lens (ICL) of varying diameter, depth, permeability and thickness can be modeled. Glucose permeability through the intracorneal lens has the most significant effect on glucose availability. The ICL profile i.e. power, can also be an important fact in determining glucose availability. A minus power design requires a thin central lens zone with a thick peripheral zone. The design results in relatively more glucose flux through the optical zone of the lens and thus improves central epithelial glucose availability.

The effect of organ culture on human trabecular meshwork

The effect of organ culture on the trabecular meshwork was studied in a series of human eyes using a perfusion culture system. One eye of a pair was cultured while the fellow eye was immediately fixed in glutaraldehyde. Culture periods ranged from 2 to 28 days, during which a mean intraocular pressure of 27 mmHg +/- 15 was maintained. The perfused culture medium appeared to leave the eye via Schlemm's canal and collector channels, mimicking the in vivo situation. The trabecular meshwork was well maintained with this system in 21 of 25 eyes. Cells remained in position on trabecular lamellae, cellular organelles usually remained normal, and the lamellae remained intact. Culture-induced changes were noted, with some cells developing intracytoplasmic lipid vacuoles and other cells developing swollen mitochondria. In addition, scattered focal cell necrosis was observed, most often in the uveal meshwork. Meshwork cellularity (nuclei:solid tissue) was determined with an image analysis system; there was an average cell loss of 20-40% in the cultured eyes as compared to their respective fellow control eyes. Overall, organ culture appears to maintain the human trabecular meshwork for at least 28 days, allowing controlled experimental studies to be performed.