Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval,...
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Transcript of Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval,...
![Page 1: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/1.jpg)
Corneal Wound: Architecture and Integrity
Luis E. Fernández de Castro, M.D.1
Helga P. Sandoval, M.D., M.S.C.R.1
Kerry D. Solomon, M.D.1
1 Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
Disclosure: L.E. Fernández de Castro-D: Alcon, Allergan, AMO; H.P. Sandoval-D: Alcon, Allergan, AMO; K.D. Solomon–A,C,D: Alcon, Allergan, AMO, Advanced Medical Research, B&L, InSite Vision,
Eyemaginations
Supported in part by NIH/NEI EY-014793 (vision core) and an unrestricted grant to MUSC-SEI from Research to Prevent Blindness, New York, NY, USA
![Page 2: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/2.jpg)
Introduction
• Surgeons transitioning from larger to smaller micro-incisions
• Incision construction is key for preventing hypotony, wound leaks, and ingress of microorganisms (endophthalmitis)
![Page 3: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/3.jpg)
Purpose
• To compare different incision sizes on clear corneal incision (CCIs) and to determine which incision width creates a square or nearly square arquitecture
![Page 4: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/4.jpg)
Materials and Methods
• A prospective study of 4 human cadaver eyes using different incisions (4) were analyzed– Particular attention was given to ensure that the
wound had a square or near square configuration– Scanning electron microscopy was used to
evaluate wound architecture in each group
3.2 mm 2.8 mm 2.6 mm 2.2 mm
![Page 5: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/5.jpg)
Materials and Methods
• After the CCIs– Corneas were fixed in 2% Cacodylate
Glutaraldehyde– Processed and examined using SEM at the Medical
University of South Carolina, Charleston, SC• Imaging was performed using a magnification factor of
50x, 100x, and 200x• Each specimen was examined and then photographed
according to a standard protocol• The outer and inner corneal wound surface were
evaluated
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Results
• Qualitative observations– On the epithelial side• All incisions were
adequately apposed– Large incision width• Rectangle
configuration – Small incision width• Square configuration
![Page 7: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/7.jpg)
3.2 mm Incision
Outer Inner
Epithelial cell loss Apposed Tear of Descemet membrane
Gapping
![Page 8: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/8.jpg)
2.8 mm Incision
Outer Inner
Epithelial cell loss Apposed Gapping
![Page 9: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/9.jpg)
2.6 mm Incision
Outer Inner
Epithelial cell loss Gapping Apposed Tear at the edge
![Page 10: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/10.jpg)
2.2 mm Incision
Outer Inner
Apposed Gapping
![Page 11: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/11.jpg)
3.2 mm
2.8 mm
2.6 mm
2.2 mm
3.2 mm
2.8 mm
2.6 mm
2.2 mm
Larger incision widths prevent a square configuration
Smaller incision widths permit a nearly squared or squared configuration
![Page 12: Corneal Wound: Architecture and Integrity Luis E. Fernández de Castro, M.D. 1 Helga P. Sandoval, M.D., M.S.C.R. 1 Kerry D. Solomon, M.D. 1 1 Magill Research.](https://reader035.fdocuments.net/reader035/viewer/2022062906/5a4d1b547f8b9ab0599a8c6b/html5/thumbnails/12.jpg)
Conclusion• Larger incision widths often preclude a square
construction due to infringement on the visual axis• Smaller incision width permit a nearly square or square
construction– Square incisions can be more stable than rectangular
• Reducing risk of hypotony• Reducing risk of wound leakage• Reducing ingress of microorganisms
• Irregular apposition and minimal gapping in endothelial edges due to direct mechanical trauma– Clinically shown to improve over time
• Ongoing study to determine wound integrity