ESCRS - PP06.18 - Outcomes Of Therapeutic Keratoplasty Using Gamma Irradiated Corneal Tissue

Outcomes Of Therapeutic Keratoplasty Using Gamma Irradiated Corneal Tissue

Published 2023 - 41st Congress of the ESCRS

Reference: PP06.18 | DOI: 10.82333/1ywa-zh18

Authors: Nguyen Viet Huong Duong 1 , Minh Vinh Lam 2 , Nguyen Huan Pham 2 , Huu Thang Diep 2 , Simon Fung 3 , Tien Dat Nguyen 4 , Thi Truc Mai Nguyen 5 , Ngoc Huy Tran 6 , Zhuang Fang 7 , Omai Garner 8 , Thi Hoang Lan Vo 4 , Quang Minh Vo 4 , Tram Duong* 9 , Anthony Aldave 3

1Ophthalmology,University of Medicine and Pharmacy at Ho Chi Minh City,Ho Chi Minh City,Viet Nam;Cornea,Ho Chi Minh City Eye Hospital,Ho Chi Minh City,Viet Nam;Jio Health,Ho Chi Minh City,Viet Nam, 2Cornea,Ho Chi Minh City Eye Hospital,Ho Chi Minh City,Viet Nam, 3Stein Eye Institute,Los Angeles,United States, 4Ophthalmology,University of Medicine and Pharmacy at Ho Chi Minh City,Ho Chi Minh City,Viet Nam, 5Cornea,Ho Chi Minh City Eye Hospital,Ho Chi Minh City,Viet Nam;Ophthalmology,Pham Ngoc Thach University of Medicine,Ho Chi Minh City,Viet Nam, 6Ophthalmology,Cho Ray Hospital,Ho Chi Minh City,Viet Nam, 7David Geffen School of Medicine at UCLA,Los Angeles,United States, 8Pathology and Laboratory Medicine,University of California Los Angeles,Los Angeles,United States, 9School of Chemistry and Molecular Biosciences,The University of Queensland,Brisbane,Australia

To evaluate the outcomes of therapeutic penetrating keratoplasty using gamma-irradiated long-term preserved corneas in managing severe corneal ulcers.

Cornea Department, Ho Chi Minh City Eye Hospital, Vietnam; from 06/2022 to 12/2022.

Prospective case series of all eyes diagnosed with severe corneal ulcer that underwent therapeutic penetrating keratoplasty using gamma-irradiated long-term preserved corneal tissue (the VisionGraft, CorneaGen) at Ho Chi Minh City Eye Hospital (Vietnam) from 06/2022 to 12/2022. All therapeutic penetrating keratoplasties were performed by two surgeons (LMV, DNVH) according to previously described surgery protocols. Main outcomes included distance visual acuity, rate of complications and evisceration, and surgeons' ease of tissue handling.

27 eyes (9 months follow up) were diagnosed with infectious keratitis. Pathogens included bacteria (high rates of antibiotic resistance), fungi, and acanthamoeba (no first-line medication available). Prior to surgery, 100% eyes had uncorrected distance visual acuity (UDVA) at counting finger or worse. At final follow up, UDVA ≥ prior to surgery except for 2 eyes (7.4%). One (3.7%) became phthisis, and one (3.7%) underwent evisceration due to advanced acanthamoebal infection. Rate of evisceration was 3.7% vs. 18% when gamma-irradiated corneal tissue had not been available. Other complications included increased intraocular pressure, suture infiltration, graft melting and infection, and phthisis. Surgeons reported ease of handling for tissue.

Gamma-irradiated long-term preserved corneal tissue is a viable alternative to fresh corneal tissues for the management of severe corneal ulcers and has the advantage of being available when needed, unlike fresh donor tissue. The ease of handling requires no learing curve. The readily availability is critical for areas with high rates of infectious keratitis, shortage of local corneal donation and reliance on imported tissue, especially with more limited transportation after the Covid pandemic.