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First Author: M.Medvedev KYRGYZSTAN
Co Author(s): N. Turgunbaev A. Poliak
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To evaluate combination of corneal cross-linking with lamellar keratoplasty and compare with lamellar keratoplasty itself in experiment
National Hospital under the Ministry of Health of Kyrgyz Republic, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyz Republic
In experiment, 15 right eyes of 15 chinchilla rabbits weithing 2.0 to 2.5 kg were divided into groups: experimental corneal cross-linking with lamellar keratoplasty, control group lamellar keratoplasty without corneal crosslinking. Observation time from 3 days till 3 months. The surgical interventions were performed under a surgical microscope at 16X magnification. Under routine antisepsis, general and topical anesthesia and blepharostasis corneal graft was created with trepan 7.0. Corneal graft fixed with 10-0 nonabsorable suture. After keratoplasty 0.1% riboflavin injected into interface between graft and cornea of recipient and eyes were exposed to a surface UVA (370nm) irradiance 4.0 mW/cmĠ during 30 minutes (Dresden protocol, Wollensak, 2003). After surgery topical 1% tetracycline ointment was administered for 1 week. Histopathological events were evaluated at 3, 7, 15, 30 and 90 days after surgery.
On the 90th day after surgery experimental group (lamellar keratoplasty+cross-linking) the area of delicate scar was covered with anterior epithelium with signs of substitutive hypertrophy and hyperplasia. Epithelial basal cells were drawn with mitosis. Activation, proliferation of keratocytes of young generation at anterior stroma. It is important to note that interface was almost invisible at this stage. Descemets membrane and endothelium were intact. In control group with lamellar keratoplasty without crosslinking interface filled with high density cells. Scar tissue was dense and non-transparent. In 2 cases (28.5%) was significant endothelial cells loss.
Morphological changes testified about positive influence of corneal cross-linking on corneal engraftment after lamellar keratoplasty: 1. Under influence of corneal crosslinking transformation of fibrocellular tissue in stroma with good optical characteristics took place 2. Interface was almost invisible after 2 months after surgery with crosslinking, but was filled with rough scar after keratoplasty without crosslinking. Combination of lamellar keratoplasty with corneal crosslinking might be promising technique in clinical use.