CHRIS A RTH | C O RNE A L TR A NSPL A NT RECIPIENT
“I see colors better than I’ve ever seen them before.” — Chris Arth, 38, Solon, Ohio. Diagnosed
with keratoconus in his left eye, Chris struggled with decreasing eyesight and ill-fitting contacts for a
decade before undergoing a corneal transplant. A graphic designer, Chris required the ability to see
details and color to perform his job. Since the transplant, Chris enjoys excellent vision.
To watch a videotaped interview with this patient, visit clevelandclinic.org/transplant.
clevelandclinic.org/transplant
COR NE AL T R AN S P L AN TAT I ON
Fast facts
In 2009, 152 corneal
transplants were
performed at Cleveland
Clinic.
See page 88 for
complete staff listing
2009 Highlights
Research and Innovations
Cole Eye Institute corneal surgeons were among the first in the country to
perform a new transplant procedure, Descemet stripping automated endothelial
keratoplasty (DSAEK). This procedure involves transplanting only the posterior
side of the cornea in eyes with endothelial dysfunction, which greatly accelerates visual recovery, reduces surgically induced astigmatism, and entails a
smaller wound with less risk of complications from an “open-sky” penetrating
keratoplasty. Cole Eye Institute surgeons have introduced several technique
modifications to improve surgical outcomes, and a clinical study is exploring the
optimal tissue preparation techniques for visual outcomes and graft survival.
Fuchs’ endothelial disease is among the leading indications in the United States
for corneal transplantation. The National Institutes of Health (NIH) is supporting
the Fuchs’ Endothelial Corneal Dystrophy study, a multicenter trial to investigate
the genetics of this disease. The study has completed enrollment and genetic
analysis is underway.
Additional research efforts include:
Primary Investigator: Dr. Steven Wilson
Corneal wound healing basic research funded by NIH and Research to Prevent
Blindness.
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clevelandclinic.org/transplant
C O R NE A L T R A N S P L A N T A T I O N
In 2009, Cole Eye Institute surgeons continued to be at the forefront of corneal
surgery and research. Team members performed 152 surgical graft procedures,
including penetrating keratoplasy, lamellar keratoplasty, deep anterior lamellar
keratoplasty, keratoprosthesis and amniotic membrane grafts. Cole Eye Institute
transplant surgeons have also implanted the Boston Keratoprosthesis as a mode
of restoring vision in patients with end-stage corneal disease, including those
with corneal blindness from severe chemical trauma.
Primary Investigator: Dr. William Dupps
Clinical and computational modeling studies of the biomechanics of keratoconus,
a major cause of corneal vision loss and leading indication for corneal transplantation in adults under 65, funded by NIH, Research to Prevent Blindness, and
the National Keratoconus Foundation/Discovery Eye Foundation. Also principal
site investigator for the NIH-sponsored Fuchs Endothelial Corneal Dystrophy
study. Principal investigator of DSAEK Donor Tissue Preparation Study.
Primary Investigator: Dr. David Meisler
NIH-sponsored corneal donor study to determine whether the graft-failure rate
over a five-year follow-up period following corneal transplantation is the same
when using corneal tissue from donors older than 65 years of age compared
with tissue from younger donors; to assess the relationship between donor/
recipient ABO blood type compatibility and graft failure due to rejection; and
to assess corneal endothelial cell density as an indicator of the health of the
cornea and as an alternate outcome measure.
Expertise
Cole Eye Institute surgeons are experts in performing all types of transplantation
procedures to treat anterior segment diseases. These procedures include:
Corneal transplantation
• Penetrating keratoplasty
• Anterior lamellar keratoplasty
• Posterior lamellar keratoplasty (Descemet Stripping Automated Endothelial
Keratoplasty (DSAEK))
Limbal stem cell transplantation
Amniotic membrane grafting
Artificial corneas
Approximately 35,000 corneal transplants are performed in the United
States every year. Medical histories of all corneal tissue donors are reviewed
carefully and blood tests are performed to check for infections. Corneal tissue
is scrutinized by specular microscopy to ascertain viability. Corneal transplant
success rates are high and rejection rates are low (with the use of only topical
immunosuppressive medications).
clevelandclinic.org/transplant
Selected Publications
Dunn SP, Stark WJ, Stulting RD, Lass JH, Sugar A, Pavilack MA, Smith PW, Tanner JP,
Dontchev M, Gal RL, Beck RW, Kollman C, Mannis MJ, Holland EJ; Cornea Donor Study
Investigator Group. The effect of ABO blood incompatibility on corneal transplant failure
in conditions with low-risk of graft rejection. Am J Ophthalmol. 2009 Mar;147(3):432438.e3. Epub 2008 Dec 4.
Jeng BH, Dupps WJ Jr. Autologous serum 50% eyedrops in the treatment of persistent
corneal epithelial defects. Cornea. 2009 Dec;28(10):1104-8.
Roy AS, Dupps WJ Jr. Effects of altered corneal stiffness on native and postoperative
LASIK corneal biomechanical behavior: A whole-eye finite element analysis. J Refract
Surg. 2009 Oct;25(10):875-87. Epub 2009 Oct 12.
de Medeiros FW, Kaur H, Agrawal V, Chaurasia SS, Hammel J, Dupps WJ Jr, Wilson SE.
Effect of femtosecond laser energy level on corneal stromal cell death and inflammation. J
Refract Surg. 2009 Oct;25(10):869-74. Epub 2009 Oct 12.
Ambrósio R Jr, Kara-José N, Wilson SE. Early keratocyte apoptosis after epithelial scrape
injury in the human cornea. Exp Eye Res. 2009 Oct;89(4):597-9. Epub 2009 Jun 11.
Wilson SE, Esposito A. Focus on molecules: interleukin-1: a master regulator of the
corneal response to injury. Exp Eye Res. 2009 Aug;89(2):124-5. Epub 2009 Feb 28.
Kaur H, Chaurasia SS, de Medeiros FW, Agrawal V, Salomao MQ, Singh N, Ambati BK,
Wilson SE. Corneal stroma PDGF blockade and myofibroblast development. Exp Eye Res.
2009 May;88(5):960-5. Epub 2008 Dec 24.
Prospero Ponce CM, Rocha KM, Smith SD, Krueger RR. Central and peripheral corneal
thickness measured with optical coherence tomography, Scheimpflug imaging, and ultrasound pachymetry in normal, keratoconus-suspect, and post-laser in situ keratomileusis
eyes. J Cataract Refract Surg. 2009 Jun;35(6):1055-62.
Rocha KM, Kagan R, Smith SD, Krueger RR. Thresholds for interface haze formation
after thin-flap femtosecond laser in situ keratomileusis for myopia. Am J Ophthalmol.
2009 Jun;147(6):966-72, 972.e1. Epub 2009 Mar 27.
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C O R NE A L T R A N S P L A N T A T I O N
Salomão MQ, Esposito A, Dupps WJ Jr. Advances in anterior segment imaging and
analysis. Curr Opin Ophthalmol. 2009 Jul;20(4):324-32.