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The Intraoperative Impression and Postoperative Outcomes of Gamma-Irradiated Corneas in Corneal and Glaucoma Patch Surgery

Daoud, Yassine J MD*; Smith, Ronald MD†; Smith, Tessie MS‡; Akpek, Esen K MD*; Ward, Donald E BA‡; Stark, Walter J MD*

doi: 10.1097/ICO.0b013e31821c9c09
Clinical Science

Purpose: To report the short-term outcome of gamma-irradiated sterile cornea in corneal and glaucoma patch graft surgeries when viable endothelium is not necessary.

Methods: Surgeons who have used the irradiated corneas were asked to rate their impression from 1 (fair) to 4 (very good). Specific intraoperative questions included availability, ease of use, clarity, thickness, tensile strength, and suturing. Postoperative outcomes included epithelialization, biological incorporation, and clarity of tissue, as well as any adverse outcomes.

Results: Irradiated sterile cornea has been used in more than 150 surgeries so far. The major uses for irradiated cornea were as glaucoma patch graft (65.3%), as corneal patch graft (14%), in anterior lamellar keratoplasty (10.7%), and in keratoprosthesis (10%). The mean score for packaging of tissue was 3.75 (SD, 0.45), ease of use 3.83 (SD, 0.39), clarity 3.62 (SD, 0.51), thickness 3.67 (SD, 0.49), tensile strength 3.64 (SD, 0.50), and suturing 3.62 (SD, 0.65). Postoperative outcomes were also favorable, including epithelialization (mean ± SD, 3.46 ± 0.69), biological incorporation (mean ± SD, 3.46 ± 0.69), and clarity (mean ± SD, 3.43 ± 0.85). There were 4 episodes of corneal melt (all occurred in patients with previous corneal melt). There were no reported cases of tissue rejection or infection.

Conclusions: Gamma-irradiated sterile cornea is a promising new development that may help increase the supply of donor cornea tissue. It virtually eliminates the risk of infection while providing a long shelf life. It is particularly helpful in emergency situations or in remote areas. However, longer follow-up and a prospective study comparing the outcomes of the irradiated corneas with those of the optisol-stored corneas are needed.

From the *Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD; †Doheney Eye Center, University of Southern California, Los Angeles, CA; and ‡National Eye Bank Center, Tissue Banks International, Memphis, TN.

Received for publication December 21, 2010; revision received March 2, 2011; accepted March 9, 2011.

The authors state that they have no proprietary interest in the products named in this article.

All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Reprints: Walter J. Stark, Wilmer Eye Institute, 600 N. Wolfe St, Baltimore, MD 21287 (e-mail: wstark1@jhmi.edu).

© 2011 Lippincott Williams & Wilkins, Inc.