Preservation of canine and feline corneoscleral tissue in Optisol GS

Early postoperative results of Descemet's stripping endothelial keratoplasty in six dogs with corneal endothelial dystrophy

OBJECTIVE

To describe and assess the clinical outcome and intraoperative and postoperative complications of Descemet's stripping endothelial keratoplasty (DSEK) in the treatment of canine corneal endothelial dystrophy.

ANIMALS STUDIED

Six dogs (six eyes) diagnosed with progressive corneal edema resulting from abnormal dystrophic endothelial cells underwent Descemet's stripping endothelial keratoplasty.

PROCEDURES

Six patients underwent Descemet's stripping endothelial keratoplasty (DSEK). The patients were examined preoperatively and postoperatively at 24 hours, 7 days, 1, 2, and 3 months after surgery. Corneal edema and ultrasonic pachymetry were evaluated preoperatively and postoperatively. The positions of DSEK grafts were evaluated 3 months after surgery using optical coherence tomography. Intraoperative and postoperative complications were noted.

RESULTS

The degree of corneal edema and corneal thickness improved postoperatively in all the patients (n = 6). Fibrin was encountered intraoperatively in one out of the six eyes (1/6) and postoperatively in two out of the six eyes (2/6). One out of the six DSEK grafts was partially scrolled (1/6). Secondary ocular hypertension was observed in one out of the six eyes (1/6). Corneal vascularization was encountered in four out of six patients (4/6).

CONCLUSIONS

Descemet's stripping endothelial keratoplasty is an effective surgical treatment option for corneal endothelial dystrophy in dogs. Corneal edema resolved and corneal thickness reduced significantly. The early postoperative results are encouraging. Further investigation is warranted to document any long-term complications and to study the longevity of the transplanted grafts.

Effect of glucose on the stress-strain behavior of ex-vivo rabbit cornea

The biomechanical changes in rabbit cornea preserved in storage media with different glucose concentrations are experimentally assessed. Two groups of eight fresh rabbit corneas were preserved for 10 days in storage medium Optisol-GS with glucose concentrations of 14 and 28 mM, respectively. Eight additional corneas preserved, glucose-free, in the same medium served as the control group. All specimens were tested under inflation conditions up to 45 mmHg posterior pressure, and the pressure-deformation data obtained experimentally were analyzed using shell theory to derive the stress-strain behavior. Comparisons were held between the three specimen groups in order to determine the effect of glucose concentration on corneal biomechanical behavior and thickness. After storage, the mean central corneal thickness in the control, low-glucose and high-glucose groups underwent statistically significant increases of 38.7 ± 11.3%, 45.4 ± 7.6% and 50.6 ± 8.6%, respectively. The corneas also demonstrated consistent stiffness increases with higher glucose concentrations. The tangent modulus values determined at different pressure levels between 10 and 40 mmHg underwent statistically significant increases with glucose level (P < 0.05). Compared to the control group, other specimens had higher tangent modulus by 17-20% on average with low glucose and 30-37% with high-glucose concentration. The results of the study indicate that the influence of the high-glucose level commonly experienced in diabetes on the biomechanical stiffness of the cornea should be considered in clinical management and in understanding corneal ectasia, glaucoma and the response to refractive surgery.

Assessment of Corneal Biomechanical Properties and Their Variation with Age

PURPOSE

The aim of this study was to determine the stress-strain behavior of corneal tissue and how the behavior was affected by age.

METHODS

Human corneal specimens ranging in age between 50 and 95 years were tested under inflation conditions to determine their stress-strain behavior. The corneas were subjected to two load rates that represent dynamic and static loading conditions. The pressure-deformation results were analyzed using shell theory to derive the stress-strain behavior.

RESULTS

The corneas demonstrated clear nonlinear behavior with an initial low stiffness stage and a final high stiffness stage. The transition between the two stages coincided with intraocular pressures between 12 and 20 mmHg. There was a considerable increase in stiffness associated with both age and load rate. Equations were derived to describe the nonlinear stress-strain relationship of corneal tissue for any age between 50 and 95 years, and these equations are presented in a form suitable for use in numerical simulations.

CONCLUSIONS

The cornea demonstrates considerable stiffening with age with the behavior closely fitting an exponential power function typical of collagenous tissue. The increase in stiffness could be related to the additional age-related nonenzymatic cross-linking affecting the stromal collagen fibrils.

Experimental assessment of corneal anisotropy

PURPOSE

To determine the variation of corneal biomechanical properties with anatomical orientation.

METHODS

Strip specimens extracted from fresh porcine corneas were tested under uniaxial tension with strain rates representing static and dynamic loading conditions. The specimens were extracted from the vertical, horizontal, and 45 degrees diagonal directions. The load elongation results were used to derive the stress-strain behavior of each specimen. The average behavior for specimens taken in each anatomical direction was determined along with the effect of strain rate. Specimens from a small number of human corneas were included in the study to verify the findings.

RESULTS

Specimens extracted from the vertical direction of porcine and human corneas demonstrated the highest strength (fracture stress) followed by horizontal then diagonal specimens. Vertical specimens were 10% to 20% stronger than horizontal specimens in porcine and human corneas. At low strain rates (1%/min), vertical specimens displayed similar stiffness (resistance to deformation) to horizontal specimens but greater stiffness than diagonal specimens. On increasing the strain rate to 500%/min, the stiffness behavior matched that of strength with vertical specimens being 10% to 20% stiffer than horizontal specimens in porcine and human corneas.

CONCLUSIONS

The corneal anisotropic behavior is compatible with the preferential orientation of stromal fibrils in the vertical and horizontal directions. Quantifying the effect of this nonuniform fibril organization on corneal anisotropic behavior will be useful in developing numerical models of the cornea for applications where its integrity is compromised such as in simulating refractive surgery procedures.

Subjective vs. objective analysis of the corneal endothelial cells in the rabbit cornea by scanning electron microscopy - a comparison of two different methods of corneal fixation

OBJECTIVE

To illustrate a method of quantitative scanning electron microscopy (SEM) for the evaluation of the corneal endothelia of small animals by comparing two commonly used fixation methods.

ANIMALS STUDIED

Female New Zealand white rabbits, aged 10-12 weeks.

PROCEDURES

The corneas were either dissected from the eye and placed in fixative (2% glutaraldehyde in 80 mm cacodylate, pH 7.4) or the whole eyeball immersed in fixative solution and the cornea dissected later. Lower (x 200) and high magnification (x 1,000-5,000) images were inspected for overall appearance. Magnification images (x 500) were used to measure the areas of 100 cells, and cell density (CD) calculated from the average area.

RESULTS

Both fixation protocols yielded an intact endothelial surface, but the dissect- then-fix protocol resulted in more creasing and distortion artifacts that were avoided with the whole-eyeball fixation. Overall, the CD values were higher if the dissect-then-fix method was used, and the uniformity of the cell mosaic was less. The median CD values for the central, mid-peripheral and peripheral regions following dissect-then-fix protocols were 7,693, 7,353, and 7,071 cells/mm(2) (average eight corneas at each location). If the whole-globe fixation was used, the median CD values were 6,098, 5,747, and 4,785 cells/mm(2).

CONCLUSION

Cell density values in SEM can be very different according to the fixation method used. A distinct regional difference in CD was evident, which was more pronounced if the cornea was fixed prior to being dissected from the eye.