1. Refining Corneal Trephination and Donor Preparation for Artificial Cornea Surgery World Cornea Congress VII April 15 - 17 2015, San Diego 2015 Behrooz Azizi, MD; Ronan Conlon, MD; Salina Teja. MD; Joshua C Teichman, MD, MPH; Season Yeung, MBBS, FRANZCO; Setareh Ziai, MD, FRCSC; Kashif Baig, MD, MBA, FRCSC University of Ottawa Eye Institute, Ottawa, Ontario, Canada

2. Financial Disclosures Drs. Azizi, Conlon, Teja, Yeung, Teichman, & Ziai have no financial relationships to disclose Dr. Baig has the following relationships: Financial Interest/ AffiliationName of Company(s) Grant/Research Support Allergan, Bausch & Lomb, Merck, Moria Employment/Honoraria/Consulting Fees/Travel Expenses Alcon, Allergan, Bausch & Lomb, Labtician Major Stock Shareholder None Member: Advisory Panel, Standing Committee, Board of Directors Allergan, Bausch & Lomb Other Financial or Material Interest None

3. Introduction  Corneal transplantation is a standard surgical treatment for many corneal diseases  However, there are situations in which replacement of the diseased cornea is best managed with an “artificial cornea”  The Boston keratoprosthesis (Kpro) is the most commonly utilized artificial cornea

4. Difficulty in achieving concentric punches Khalifa YM, Moshirfar M. Improved centration of the type 1 Boston Keratoprosthesis in donor carrier tissue. Clin Ophthalmol. 2010 Aug 19;4:931-3

5. Difficulty in achieving concentric punches Khalifa YM, Moshirfar M. Improved centration of the type 1 Boston Keratoprosthesis in donor carrier tissue. Clin Ophthalmol. 2010 Aug 19;4:931-3

6. Difficulty in achieving concentric punches John T. Use of trypan blue corneal staining and centration ring in Boston keratoprosthesis surgery. Techniques in Ophthalmology. 2009 Dec. 7(4):127-130

7. Purpose  To devise a simple and cost-effective device for the preparation of the donor corneal tissue for Kpro surgery.  This device will perform the outer 8mm and inner 3mm cuts with increased accuracy and precision to improve centration.

8. Methods  30 donor corneas that were not suitable for transplantation  3 arms (1:1:1 design)  3mm followed by 8mm punch  8mm followed by 3mm punch  Paired 3mm & 8mm punches utilizing the prototype  Computer software (Adobe Photoshop, San Jose, CA) was used to measure the centration of the punches by a masked examiner  Descriptive & inferential statistics were performed

9. Methods

10. Results – Decentration Error bars = ± SEM * P<0.0001

11. Results – Decentration

12. Conclusions  Our study demonstrates that pairing the two trephinations on the donor cornea with the use of a single device leads to increased predictability & ease of trephination