Mechanical Stability of Microkeratome-Assisted Intracorneal KeratoprosthesisImplantation | Cornea | JAMA Ophthalmology | JAMA Network
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Laboratory Sciences
December 2004

Mechanical Stability of Microkeratome-Assisted Intracorneal KeratoprosthesisImplantation

Author Affiliations

Author Affiliations: Department of Ophthalmology,College of Medicine (Drs Erb, Taban, Barsam, and Chuck and Ms Sweet) and Departmentof Biomedical Engineering (Dr Chuck), University of California, Irvine. DrChuck is currently affiliated with the Wilmer Ophthalmological Institute,Johns Hopkins University, Baltimore, Md.

Arch Ophthalmol. 2004;122(12):1839-1843. doi:10.1001/archopht.122.12.1839

Objective  To develop a laboratory model to study intracorneal keratoprosthesisimplantation.

Methods  A combination microkeratome and artificial anterior chamber system wasused to create a hinged lamellar keratectomy on 13 human corneas. After reflectingthe flap, the posterior stroma was trephined at either 2.5 or 3.0 mm. A modelkeratoprosthesis was positioned in the bed. The flap was sutured closed. Intrachamberpressure was increased, and wound leak pressure was recorded. The anteriorcorneal lamella was trephined at either 3.0 or 3.5 mm to expose the keratoprosthesis.Leak pressure was again determined.

Results  After keratoprosthesis placement and prior to anterior trephination,all 13 corneas were watertight at maximum attainable intrachamber pressures.With posterior/anterior trephination combinations of 2.5/3.0 mm, 2.5/3.5 mm,or 3.0/3.5 mm, mean ± SD wound leak pressure occurred at95 ± 12 mm Hg, 32 ± 7 mm Hg, or 59 ± 12mm Hg, respectively (P<.01).

Conclusions  With a posterior trephination of 2.5 mm, there is significant keratoprosthesis-corneainterface destabilization between a 3.0- and 3.5-mm anterior trephination.For an anterior trephination of 3.5 mm, interface destabilization improvesby increasing the posterior trephination to 3.0 mm.

Clinical Relevance  An intracorneal keratoprosthesis may be implanted using microkeratomeassistance. Our laboratory model provides a useful method for examining arange of posterior and anterior trephination diameters and their effects onthe mechanical stability of intracorneal keratoprosthesis placement.