title: Microkeratome assisted deep lamellar keratoprosthesis.
abstract: OBJECTIVE
  To establish a keratoprosthesis (Kpro) surgical technique that maintains an intact superficial corneal layer.
  
  
  METHODS
  A manual microkeratome (Moria LSK-1) was used to create a 130 mum flap of approximately 10 mm diameter in the right eye of Japanese white rabbits. The stoma beneath the flap area was dissected before the removal of a 5.0 mm stromal disc. A 5.0 mm collagen I immobilised poly(vinyl alcohol) (COL-PVA) disc was placed on the exposed posterior stroma close to Descemet's membrane. The flap was repositioned and fixed using 10-0 nylon sutures, which were removed 2 days following surgery. The corneas were followed clinically by slit lamp microscopy and photographs. Rabbits were sacrificed after 6 months, and the transplanted corneas were examined histologically by haematoxylin and eosin staining and immunohistochemistry against vimentin and alpha-smooth muscle actin (alpha-SMA).
  
  
  RESULTS
  The transplanted COL-PVA discs remained transparent throughout the study, with no complications related to the flap or overlying epithelium. The interface between COL-PVA and Descemet's membrane remained clear without signs of opacification caused by scarring or cellular deposition. Pathology revealed the intact COL-PVA polymer in the posterior stroma, with minimal cellular infiltration along the anterior and posterior interfaces. Immunohistology shows vimentin and alpha-SMA staining at levels comparable to lamellar keratoplasty control.
  
  
  CONCLUSIONS
  Microkeratome assisted deep lamellar keratoprosthesis may be a safe technique for the transplantation of artificial hydrogels for therapeutic purposes.
authors.affiliation: Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. shige@sc.itc.keio.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Shimmura
authors.forename: H
authors.initials: H
authors.lastname: Miyashita
authors.forename: Y
authors.initials: Y
authors.lastname: Uchino
authors.forename: T
authors.initials: T
authors.lastname: Taguchi
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: J
authors.initials: J
authors.lastname: Shimazaki
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: K
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000818:Animals; D003315:Cornea / Q000601:surgery*; D016039:Corneal Transplantation / Q000295:instrumentation / Q000379:methods; D005260:Female; D020100:Hydrogels; D008866:Microsurgery / Q000379:methods*; D011142:Polyvinyl Alcohol; D019919:Prosthesis Implantation / Q000379:methods*; D011817:Rabbits; D013524:Surgical Flaps; D014945:Wound Healing
chemical_list: D020100:Hydrogels; D011142:Polyvinyl Alcohol