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Translational Whole Eyeball Transplantation Model-Porcine
Vasil E. Erbas, MD1, Huseyin Sahin, MD1, Liwei Dong, MD1, Maxine R. Miller, MD1, Golnar Shojaati, MD1, Mario Solari, MD1, Kia M. Washington, MD1, Vijay S. Gorantla, MD, PhD1. 1University of Pittsburgh, Pittsburgh, PA,
University of Pittsburgh
2016-01-31
Presenter: Vasil Erbas
Affidavit:
I would like to confirm the work fellow has done on the study.
Director Name: Vijay S. Gorantla
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Purpose: Whole eyeball transplantation (WET) is the holy grail of vision restoration and is conceptually the most challenging of vascularized composite allografts (VCA). The swine eye is analogous to the human and is the ideal model for human WET. Our goal was to define technical considerations (surgical planning/procedures/post operative imaging /evaluations) in a robust, large animal, preclinical, translatable WET model.
Methods: WET techniques were optimized in 17 fresh tissue swine dissections. An eyeball-periorbital VCA subunit with extra ocular muscles, and optic nerve (ON) was raised superolaterally and anastomosed to the recipient external ophthalmic artery (EOA) after exenteration. Perfusion was confirmed with methylene blue and vascular territories [central retinal artery (CRA), ciliary and vortex plexuses] defined by microfil. Orbital contents and ON were imaged with dynamic contrast enhanced (DCE-MRI) and diffusion tensor imaging (DTI) [T1/T2 MRI at 3T/7T/9.4T]. Advanced protocols for histopathology, immunohistochemistry, epoxy embedding, corrosion casting, optical coherence tomography (OCT), tonometry, fundoscopy and ERG were optimized and surgical techniques for ON crush, cut and coaptation established
Results: Like the human, the swine retina is holangiotic and the ON has a lamina cribrosa. However, the CRA is absent and the predominant arterial supply is from the EOA. OCT and MRI allowed real-time, high definition, non-invasive, in situ, micron-scale, cross-sectional visualization of structure/topography of ocular structures.
Conclusion: Our study is the critical first step towards a swine WET model optimized for viability, retinal survival, ON regeneration and reintegration while documenting key immune responses, and enabling key neuro-immuno-therapeutic interventions.
