Regional EuroTimes
Date Posted 14/06/2009
Coaxial microincisional surgery feasible through biosynthetic corneal transplant
Presence of a biosynthetic corneal transplant does not present a contraindication to cataract surgery. However, special attention must be directed to the use of surgical strategies that will improve visibility and safety in such a procedure where there is altered corneal structure and clarity, said Bjorn Johansson MD, PhD, Linkoping University Hospital, Sweden.
Dr Johansson presented the first clinical case of phacoemulsification performed in an eye with a biosynthetic corneal transplant. The patient was a 75-year-old woman who is participating in a Phase 1 clinical trial of the investigational graft, which is made of crosslinked human recombinant collagen and bioengineered by May Griffith PhD, and colleagues.
The patient had moderate bilateral cataracts at study enrollment and received the biosynthetic corneal transplant in her left eye that was affected by keratoconus. Cataract surgery with IOL implantation was performed one year later due to deteriorating vision.
For the procedure, Dr Johansson performed 1.8mm coaxial microincision cataract surgery (C-MICS) using the Stellaris Vision Enhancement System (Bausch & Lomb). Coating the cornea with a hydroxypropyl methylcellulose viscoelastic (Ocucoat, Bausch & Lomb) was very useful for improving intraoperative visibility, which was compromised because the corneal transplant had a slight haze, and continuous curvilinear capsulorhexis was completed without the need for trypan blue. Removal of the cataract, which was soft and brittle, was completed safely.
“Maximum chamber stability is important when operating in an eye where there is decreased visibility. Modern phacoemulsification platforms, such as the Stellaris, use various technical solutions to provide this,” said Dr Johansson.
An Akreos MI60 IOL (Bausch & Lomb) was implanted through the unenlarged 1.8mm incision. Dr Johansson noted he prefers this aspheric-neutral IOL in eyes where there is an irregular cornea as he feels it is best not to induce any aberrations, either a positive or negative.
With a postoperative protocol including three weeks of topical corticosteroid treatment, the patient had an uncomplicated postoperative course. Visual acuity improved, but only to a limited extent due to irregular corneal astigmatism in the biosynthetic transplant.
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