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Case Reports
, 8 (5), 558-62

Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High-Risk Patients

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Case Reports

Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High-Risk Patients

Oleksiy Buznyk et al. Clin Transl Sci.

Abstract

Corneas with severe pathologies have a high risk of rejection when conventionally grafted with human donor tissues. In this early observational study, we grafted bioengineered corneal implants made from recombinant human collagen and synthetic phosphorylcholine polymer into three patients for whom donor cornea transplantation carried a high risk of transplant failure. These patients suffered from corneal ulcers and recurrent erosions preoperatively. The implants provided relief from pain and discomfort, restored corneal integrity by promoting endogenous regeneration of corneal tissues, and improved vision in two of three patients. Such implants could in the future be alternatives to donor corneas for high-risk patients, and therefore, merits further testing in a clinical trial.

Keywords: collagen; epithelium; grafting; patients; remodeling; transplantation.

Figures

Figure 1
Figure 1
Schematic diagram showing the combination of recombinant human collagen type III (RHCIII) and 2‐methacryloyloxyethyl phosphorylcholine (MPC) to form interpenetrating networks of RHCIII‐MPC. The RHCIII and MPC were mixed together in a syringe, while the final hydrogel was molded into an implant. An image of Vladimir Filatov, pioneer of human donor cornea grafting, can be seen through the transparent implant.
Figure 2
Figure 2
Corneas of all three patients before and after implantation with tectonic grafts of RHCIII‐MPC. Patient 1's cornea had an ulcer overlying a vascularized stroma. The green fluorescein staining delineates the large area of eroded epithelium. At 12 months postoperation, the cornea is intact and relatively clear. Patient 2 had a failed 8.5‐mm‐diameter graft with a persistent ulcer and dense stromal opacification in the visual zone prior to surgery. A small 4‐mm implant was grafted into the ulcerated area of the failed graft (arrowhead) and has remained relatively clear after 12 months. Patient 3 had an opacity with an unstable epithelial surface and vascularized stroma prior to surgery. At 9 months postoperation, while the implant remained clear, the ingrowing conjunctiva has left the surface hazy.
Figure 3
Figure 3
Restoration of touch sensitivity after grafting with RHCIII‐MPC implants as an indication of nerve function restoration. Central corneal touch sensitivity was assessed by contact esthesiometry in the patients’ corneas before and after implantation, with the nonoperated, contralateral eyes serving as controls. Measurements were obtained using a Cochet–Bonnet esthesiometer with a monofilament, where an increase in filament length (mm) corresponds to an increase in touch sensitivity (n = 3 patients).
Figure 4
Figure 4
In vivo confocal microscopy through an implanted cornea at 12 months postoperation showing regenerated patient epithelium (A) that resembles that of a healthy cornea (B). Stromal cells have grown into the initially cell‐free graft, although partially obscured by haze (C), unlike the healthy cornea where the cells are clearly visible (D). The preserved patient endothelium (E) has a number of larger sized cells but also endothelial cells that resemble those of a healthy cornea (F).

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