The 90 percent to 95 percent success rate for corneal transplantation in the United States might sound impressive, but Stephen Kaufman, M.D., Ph.D., isn’t satisfied.
Certain high-risk patients still face transplant rejection and related problems, and Kaufman hopes his research can help these patients.
Kaufman, who is regarded as an innovative leader in corneal transplantation research, joined the Department of Ophthalmology at the University of Minnesota in June as a professor and the director of cornea and refractive surgery. He comes to the University from Case Western Reserve University Medical School in Cleveland, Ohio, and from Wayne State University in Detroit, Michigan. He was also director of cornea and refractive surgery at Henry Ford Health System, a large private health-care system in Detroit, where he worked in two satellite clinics and taught residents. But there, limited resources were available for education and research.
The opportunity to continue his research attracted Kaufman to the University of Minnesota. That opportunity presented itself last year when Kaufman met Department of Ophthalmology chair Jay Krachmer, M.D., at a professional meeting.
“Dr. Krachmer is very well-known in our field and has written several textbooks,” Kaufman says. “He and I have mutual interests, and he is interested in the research I do.”
Krachmer says he’s glad to have another seasoned specialist on the department’s cornea team, which besides Krachmer includes Donald Doughman, M.D.
“We feel very fortunate to have Dr. Kaufman with us,” Krachmer says. “He brings vast experience in all phases of cornea and external eye disease diagnosis and management, both medical and surgical. He also brings valuable experience in refractive surgery to the department.”
Reducing rejection rates
Corneal transplantation is one of the most common tissue transplant procedures. During the surgery, the cornea—the clear surface on the front of the eye—is replaced with tissue from a donor eye.
Transplants are recommended for a variety of reasons, including thinning of the cornea that causes vision problems, cloudiness of the cornea that causes vision loss, or cornea scarring from severe infections or injuries.
Kaufman is interested in the anatomy of the cornea and the cellular biology within it. Some of his research involves working with new medications to suppress rejection after high-risk individuals receive a corneal transplant. (Those whose bodies have rejected a corneal transplant in the past and those who’ve had new blood vessels grow into their damaged corneas are considered to be at high-risk for rejection.)
Steroid eye drops have been effective in increasing the success rate for these high-risk patients, Kaufman says, and a newer medication in ointment form has shown promise as well.
Additional research, which will be conducted on donated eye tissue from the Minnesota Lions Eye Bank before it is performed on humans, will examine the best way to prepare tissue for a new type of transplant that involves replacing just a single cell layer inside the cornea.
“We know we can remove those cells, but we don’t know how to best get those cells from the donor eye into the patient’s eye,” Kaufman says. “Is it best if the layer is thinner? If it’s prepared the day of surgery or three days ahead of time? That’s what we’re going to look at.”
Tackling eye diseases with technology
While studying for his doctorate in cell biology, Kaufman developed a confocal microscope for use in ophthalmology. This powerful, specialized microscope makes it possible to see cellular detail in the cornea and other parts of the eye. All five layers of the cornea can be seen through this instrument—without stains or dyes—via a video camera and television monitor.
“With this microscope, bacteria, fungus, and amoeba are visible in the cornea, and you know right away what you’re dealing with, as opposed to sending a culture to a lab, which can take days or even weeks to get results,” Kaufman says. “You can immediately tell the difference between an infection and swelling of the cornea. This is an invaluable tool when you’re dealing with corneal graft rejection.”
This specialized microscope is expensive and uncommon, but the department has recently ordered one.
“Having a confocal microscope will put us on the cutting edge,” he says. “It will help us diagnose diseases and can be used for research, too. It will also be an important tool for teaching ophthalmology residents and fellows.”