Ruo Zhong Xie

Synthetic corneal inlays

This review is based on the activities of the Vision Cooperative Research Centre (previously Cooperative Research Centre for Eye Research and Technology) Corneal Implant team from 1991 to 2007. The development of a synthetic polymer of perfluoropolyether (PFPE), meeting essential physical and biological requirements, for use as a corneal inlay is presented. Each inlay was placed in a corneal flap created with a microkeratome and monitored over a two‐year period in a rabbit model. The results indicate that the PFPE implant shows excellent biocompatibility and biostability. As a result, a Phase 1 clinical trial is being conducted. Three years post‐implantation, the PFPE inlays are exhibiting continued excellent biocompatibility. Corneal inlays made from PFPE are biocompatible with corneal tissue in the long term and offer a safe and biologically‐acceptable alternative to other forms of refractive surgery.

The use of corneal organ culture in biocompatibility studies

This study investigated the potential of a corneal organ culture system in the evaluation of polymers for ophthalmic devices that require epithelialisation. Two different polymers were tested in lenticule form to explore the sensitivity of this in vitro assay. Polycarbonate and perfluoropolyether-based lenticules were surgically implanted into bovine corneas and compared with a parallel series of sham-wounded corneas. Following surgery, all corneas were maintained in an air/liquid organ culture system for up to 8 days during which time they were evaluated clinically to monitor the rate of epithelial growth across the lenticule surface (implanted) or wound bed (sham). Data showed differences in the kinetics of epithelial migration according to the underlying surface with full epithelialisation of the sham series occurring on day 5+/-0.5, the perfluoropolyether lenticules on day 6+0.5 and polycarbonate lenticules on day 8+/-0.5. Histology revealed differences in the structure and morphology of the migrating and stable epithelium in each series of corneas. The differential response of the corneal epithelium was related to the physiochemical characteristics of the natural (sham) or synthetic (perfluoropolyether or polycarbonate) substrata which the epithelium could detect when maintained in organ culture. This assay system has utility for screening candidate polymers for certain ophthalmic applications.

Artificial Cornea: Towards a Synthetic Onlay for Correction of Refractive Error

Synthetic onlays that are implanted onto the surface of the cornea have the potential to become an alternative to spectacles and contact lenses for the correction of refractive error. A successful corneal onlay is dependent on development of a biocompatible polymer material that will maintain a healthy cornea after implantation and that will promote growth of corneal epithelial cells over the onlay, and development of a method for attachment of the onlay with minimal surgical invasiveness. The ideal onlay should be made of a material that is highly permeable yet has sufficient surface characteristics to stimulate stable and firm attachment of the corneal epithelium over the onlay. Recent research indicates that collagen I coated polymer materials that mimic the basement membrane of the corneal epithelium promote the most favorable growth of epithelial cells in vivo in comparison to wholly biological or synthetic materials.

The influence of surface topography of a porous perfluoropolyether polymer on corneal epithelial tissue growth and adhesion

Design principles for corneal implants are challenging and include permeability which inherently involves pore openings on the polymer surface. These topographical cues can be significant to a successful clinical outcome where a stratified epithelium is needed over the device surface, such as with a corneal onlay or corneal repair material. The impact of polymer surface topography on the growth and adhesion of corneal epithelial tissue was assessed using porous perfluoropolyether membranes with a range of surface topography. Surfaces were characterised by AFM and XPS, and the permeability and water content of membranes was measured. Biological testing of membranes involved a 21-day in vitro tissue assay to evaluate migration, stratification and adhesion of corneal epithelium. Similar parameters were monitored in vivo by surgically implanting membranes into feline corneas for up to 5 months. Data showed optimal growth and adhesion of epithelial tissue in vitro when polymer surface features were below a 150 nm RMS value. Normal processes of tissue growth and adhesion were disrupted when RMS values approached 300 nm. Data from the in vivo study confirmed these findings. Together, outcomes demonstrated the importance of surface topography in the design of implantable devices that depend on functional epithelial cover.