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Angerer MPM, Weller JM, Kruse FE, Hille K. Long-Term Outcomes of Keratoprosthesis With Biological Haptic: A Review of 25 Years of Single-Center Surgeries. Cornea 2024:00003226-990000000-00498. [PMID: 38391267 DOI: 10.1097/ico.0000000000003495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024]
Abstract
PURPOSE To study the outcome of eyes that underwent surgery for keratoprosthesis with a biological haptic, osteo-odonto-keratoprosthesis (OOKP) or tibia keratoprosthesis, by a single surgeon over a time span of more than 25 years. METHODS One hundred thirty eyes that had received a keratoprosthesis with a biological haptic between 1994 and 2022 by a single surgeon were included in this retrospective analysis. Main outcome parameters were postoperative best corrected visual acuity, postoperative refractive error, postoperative complications, anatomical and functional survival of the prosthesis as well as comparison of subgroups of the 2 different types (OOKP n = 78; tibia keratoprosthesis n = 52) of keratoprostheses, and subgroup analysis of different indications for surgery. Patients were examined every 6 months. RESULTS The longest follow-up was 25.8 years. Reasons for implantation were graft-vs-host disease (6.9%), vascularized corneas and dry eye (22.9%), physical or chemical burns (29.8%), Stevens-Johnson syndrome (9.9%), and ocular cicatricial pemphigoid (30.5%). The functional success rate with postoperative visual acuity of better than 0.7 log MAR was achieved by 56.9%. The OOKP subgroup showed a better mean visual outcome. 14 keratoprostheses (10.7%) had to be explanted over the whole time span. In the time leading to explantation, refraction showed a statistically significant myopic shift when compared with the non-explanted prosthesis. Anatomical survival rates were better for the OOKP in the first 12 years after implantation. CONCLUSIONS The study shows that keratoprosthesis with a biological haptic has favorable long-term outcomes. The retention rate stayed very high with excellent functional outcomes.
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Affiliation(s)
- Maximilian P M Angerer
- Department of Ophthalmology, Friedrich-Alexander University Erlangen Nürnberg, Erlangen, Germany; and
- Department of Ophthalmology, Ortenau Klinikum Offenburg, Offenburg, Germany
| | - Julia M Weller
- Department of Ophthalmology, Friedrich-Alexander University Erlangen Nürnberg, Erlangen, Germany; and
| | - Friedrich E Kruse
- Department of Ophthalmology, Friedrich-Alexander University Erlangen Nürnberg, Erlangen, Germany; and
| | - Konrad Hille
- Department of Ophthalmology, Ortenau Klinikum Offenburg, Offenburg, Germany
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2
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Aoun T, Harissi-Dagher M. [Long-term visual outcomes of Boston type I keratoprosthesis in Canada]. J Fr Ophtalmol 2023; 46:1212-1221. [PMID: 37867123 DOI: 10.1016/j.jfo.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/11/2023] [Accepted: 07/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND/PURPOSE To evaluate long-term visual outcomes of Boston type I keratoprosthesis (KPro) surgery and identify risk factors for visual failure. METHODS Single surgeon retrospective cohort study including 85 eyes of 74 patients who underwent KPro implantation to treat severe ocular surface disease, including limbal stem cell deficiency, postinfectious keratitis, aniridia and chemical burns. Procedures were performed at the Centre hospitalier de l'Université de Montréal from October 2008 to May 2012. All patients with at least 5 years of follow-up were included in the analysis, including eyes with repeated KPro. Main outcome measures were visual acuity (VA), visual failure, defined as a sustained VA worse than the preoperative VA, postoperative complications, and device retention. RESULTS Mean follow-up was 7.2±1.3 years (±SD). Mean VA was 2.1±0.7 (logarithm of minimal angle resolution) preoperatively and 1.9±1.2 at last follow-up. In total, 2.4% of patients had VA better than 20/200 preoperatively vs. 36.5% at last follow-up. Maintenance of improved postoperative VA was seen in 61.8% of eyes at 7 years. Preoperative factors associated with visual failure were known history of glaucoma (HR=2.7 [1.2 to 5.9], P=0.02) and Stevens-Johnson syndrome (HR=7.3 [2.5 to 21.4], P<0.01). Cumulative 8-year complication rates were 38.8% retroprosthetic membrane formation, 25.9% hypotony, 23.5% new onset glaucoma, 17.6% retinal detachment, 8.2% device extrusion and 5.9% endophthalmitis. The majority (91.8%) of eyes retained the device 8 years after implantation. CONCLUSION Nearly two-thirds of patients exhibited improved VA 7 years after KPro implantation. Preoperative risk factors for visual failure were known glaucoma and Stevens-Johnson syndrome.
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Affiliation(s)
- T Aoun
- Faculté de médecine, université de Montréal, Montréal, Canada
| | - M Harissi-Dagher
- Centre hospitalier de l'université de Montréal (CHUM), Montréal, Canada.
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3
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Wu KY, Mina M, Carbonneau M, Marchand M, Tran SD. Advancements in Wearable and Implantable Intraocular Pressure Biosensors for Ophthalmology: A Comprehensive Review. MICROMACHINES 2023; 14:1915. [PMID: 37893352 PMCID: PMC10609220 DOI: 10.3390/mi14101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Glaucoma, marked by its intricate association with intraocular pressure (IOP), stands as a predominant cause of non-reversible vision loss. In this review, the physiological relevance of IOP is detailed, alongside its potential pathological consequences. The review further delves into innovative engineering solutions for IOP monitoring, highlighting the latest advancements in wearable and implantable sensors and their potential in enhancing glaucoma management. These technological innovations are interwoven with clinical practice, underscoring their real-world applications, patient-centered strategies, and the prospects for future development in IOP control. By synthesizing theoretical concepts, technological innovations, and practical clinical insights, this review contributes a cohesive and comprehensive perspective on the IOP biosensor's role in glaucoma, serving as a reference for ophthalmological researchers, clinicians, and professionals.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Mina Mina
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marjorie Carbonneau
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Michael Marchand
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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4
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van Velthoven AJH, Utheim TP, Notara M, Bremond-Gignac D, Figueiredo FC, Skottman H, Aberdam D, Daniels JT, Ferrari G, Grupcheva C, Koppen C, Parekh M, Ritter T, Romano V, Ferrari S, Cursiefen C, Lagali N, LaPointe VLS, Dickman MM. Future directions in managing aniridia-associated keratopathy. Surv Ophthalmol 2023; 68:940-956. [PMID: 37146692 DOI: 10.1016/j.survophthal.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
Congenital aniridia is a panocular disorder that is typically characterized by iris hypoplasia and aniridia-associated keratopathy (AAK). AAK results in the progressive loss of corneal transparency and thereby loss of vision. Currently, there is no approved therapy to delay or prevent its progression, and clinical management is challenging because of phenotypic variability and high risk of complications after interventions; however, new insights into the molecular pathogenesis of AAK may help improve its management. Here, we review the current understanding about the pathogenesis and management of AAK. We highlight the biological mechanisms involved in AAK development with the aim to develop future treatment options, including surgical, pharmacological, cell therapies, and gene therapies.
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Affiliation(s)
- Arianne J H van Velthoven
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands; University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Tor P Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Maria Notara
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dominique Bremond-Gignac
- Ophthalmology Department, University Hospital Necker-Enfants Malades, APHP, Paris Cité University, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Paris Cité University, Paris, France
| | - Francisco C Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK; Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Heli Skottman
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Daniel Aberdam
- Centre de Recherche des Cordeliers, Sorbonne Paris Cité University, Paris, France
| | | | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Hospital, Milan, Italy
| | - Christina Grupcheva
- Department of Ophthalmology and Visual Sciences, Medical University of Varna, Varna, Bulgaria
| | - Carina Koppen
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Mohit Parekh
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas Ritter
- Regenerative Medicine Institute, University of Galway, Galway, Ireland
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy
| | | | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Neil Lagali
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Vanessa L S LaPointe
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - Mor M Dickman
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands; University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
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Milad D, Yang Y, Eisa K, Harissi-Dagher M. Review of clinical trials addressing the Boston Keratoprosthesis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00166-7. [PMID: 37253429 DOI: 10.1016/j.jcjo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/24/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The Boston Keratoprosthesis (KPro) has gained recognition as an alternative for patients with severe corneal disease and a poor probability of success with traditional penetrating keratoplasty. This review summarizes the knowledge clinical trials have brought to KPro and discusses ongoing trials. DESIGN Systematic review. METHODS A literature review across PubMed, Ovid MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov was performed to identify relevant published clinical trials reporting on the KPro from all years up until September 2021. All published trials were included. RESULTS There are 6 published and 6 ongoing clinical trials studying the Boston KPro. The number of patients included per trial ranged from 8 to 37. The average age of patients included per trial ranged from 39 to 62 years. Patients were followed for an average of 36.3 ± 41.8 months. Fifty percent (3 of 6) of KPro clinical trials were randomized. Indication for KPro was reported in 67% of trials (4 of 6), with primary KPro accounting for 22% of unique eyes (13 of 58) and KPro after corneal graft failure accounting for 41% of unique eyes (24 of 58), when reported. Using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess quality and risk of bias, 50% of trials (3 of 6) had a low risk of bias, 33% (2 of 6) had some bias concerns, and 17% (1 of 6) had a high risk of bias. CONCLUSIONS There are few clinical trials published and underway on the Boston KPro, and none directly compare KPro outcomes with repeat corneal transplantation. There is a need for long-term clinical trials on the KPro to provide quality evidence for clinical decision making.
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Affiliation(s)
- Daniel Milad
- Department of Ophthalmology, University of Montreal Health Centre (CHUM), Montreal, Que
| | - Yelin Yang
- Department of Ophthalmology, University of Montreal Health Centre (CHUM), Montreal, Que
| | - Kerolos Eisa
- Department of Public Health, Queens University, Kingston, Ont
| | - Mona Harissi-Dagher
- Department of Ophthalmology, University of Montreal Health Centre (CHUM), Montreal, Que..
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Glaucoma management in patients with penetrating keratoplasty or keratoprosthesis. Curr Opin Ophthalmol 2023; 34:95-102. [PMID: 36730770 DOI: 10.1097/icu.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Advances in surgical techniques and postoperative care have significantly improved rates of short-term complications following keratoplasty; however, glaucoma remains a highly prevalent long-term and potentially devastating complication for postkeratoplasty patients. In this review, we provide an overview of recent literature on glaucoma management in patients who have undergone penetrating keratoplasty or the Boston keratoprosthesis type I (KPro) implantation. RECENT FINDINGS New research suggests an inflammatory cause underlying glaucoma following KPro. Accurate IOP measurement is difficult in patients postkeratoplasty; study of objective techniques such as PDCT or Tono-Pen in penetrating keratoplasty eyes and trans-palpebral Diaton tonometry in KPro eyes have shown promising results. Early glaucoma surgical intervention should be considered for patients undergoing penetrating keratoplasty and KPro. SUMMARY Patients who have undergone penetrating keratoplasty or implantation of the Boston keratoprosthesis type I should be monitored frequently for elevated intraocular pressure and for other signs of glaucomatous optic nerve damage. Intraocular pressure elevation should be treated promptly either medically or surgically while minimizing risk to the corneal graft. Further research into inflammatory causes and other treatment modalities is promising for the long-term visual success in these patients.
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A New Contact Lens Sensor System for Continuous Intraocular Pressure Monitoring: Evaluation of Safety and Tolerability. Eye Contact Lens 2022; 48:439-444. [PMID: 35984110 DOI: 10.1097/icl.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess the safety and tolerability of a new contact lens sensor (CLS) system for continuous 3- and 24-hr intraocular pressure (IOP) monitoring in human eyes. METHODS Twenty-five subjects were recruited for 3-hr IOP measurement by CLS. Corneal fluorescein staining (CFS) scores were evaluated before and after measurement. Then, 30 participants (10 normal subjects and 20 glaucoma patients) were recruited for 24-hr IOP monitoring. Ocular surface disease index (OSDI) was assessed before and one day after measurement. Contact lens dry eye questionnaire-8 was assessed immediately after measurement. Visual analog scale of discomfort was measured before, immediately after, and one day after measurement. Best-corrected visual acuity (BCVA), tear break-up time (TBUT), and CFS were assessed before, immediately after, and 1 day after measurement. RESULTS All participants completed 3- or 24-hr IOP measurement by CLS. Corneal fluorescein staining increased from 0.6±0.7 to 2.4±1.5 after 3-hr IOP measurement ( P <0.001). For participants undergoing 24-hr IOP monitoring, OSDI increased from 9.1±9.7 to 18.0±12.4 ( P =0.001). CLDEQ-8 score was 11.6±5.8. Visual analog scale increased from 11.1±14.2 to 35.2±21.8 after measurement ( P <0.001) and decreased to 26.7±18.4 one day later ( P <0.001 compared with baseline). BCVA decreased from 1.0±0.01 to 0.8±0.1 ( P <0.001) and returned to 0.9±0.1 after one day ( P <0.001 compared with baseline). TBUT decreased from 5.1±3.9 to 2.6±1.5 s ( P =0.001) and returned to 4.8±2.5 s ( P =0.465 compared with baseline). Corneal fluorescein staining increased from 0.7±0.9 to 4.3±0.8 ( P <0.001) and dropped to 0.8±0.7 ( P =0.599 compared with baseline). No significant difference was found for all variations of indicators between normal subjects and glaucoma patients ( P >0.1 for all comparisons). CONCLUSIONS The CLS shows a great potential for a safe and tolerable 24-hr IOP monitoring in normal subjects and glaucoma patients. Clinical attention to the worsening signs and symptoms after measurement is required.
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Bachmann B, Schaub F, Cursiefen C. [Keratoprostheses: Last Hope for the Most Severe Corneal Diseases]. Klin Monbl Augenheilkd 2022; 239:1165-1179. [PMID: 35970191 DOI: 10.1055/a-1892-6142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Corneal blindness affects over 8 million adults and 1.5 million children worldwide, making it one of the top 5 causes of blindness. Depending on the recipient's corneal condition corneal transplantation may not be a viable treatment option. In such seemingly no-alternative situations, keratoprosthesis implantation can be an option in some patients. In terms of numbers, two types of keratoprostheses are currently used: 1. Keratoprostheses with biological haptics made of tooth or tibia bone. 2. The Boston type I-keratoprosthesis. Both types have optics made of PMMA. The most common complication is the formation of an optically disturbing retroprosthetic membrane behind the optic, which can usually be removed with YAG laser. Causes of blindness after keratoprosthesis implantation are glaucoma, endophthalmitis and retinal detachment. The extrusion rate of the Boston type I-keratoprosthesis seems to be higher than after keratoprosthesis implantation with biological haptic. Autoimmunological corneal diseases have increased extrusion rates and higher rates of endophthalmitis when compared to non-autoimmunological diseases. Visual outcomes after keratoprosthesis implantation are potentially very good and usually limited by extracorneal concomitant diseases. Advances in glaucoma diagnostic (OCT, implantation of intraocular pressure sensors), standard glaucoma prophylaxis by medication or surgery, modern retinal surgery and better treatment options in case of extrusion improve the prognosis of keratoprosthesis surgery. Still, the ideal technique for permanent anchoring of artifical optics in biological tissue has yet to be developed.
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Bachmann B, Schaub F, Cursiefen C. Keratoprothesen: letzte Hoffnung bei schwersten
Hornhauterkrankungen. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1488-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungEine Vielzahl an Hornhauterkrankungen geht mit einem hohen Versagensrisiko von
Hornhauttransplantaten einher. Häufig handelt es sich um Patienten mit
beidseitig hornhautbedingter Blindheit ohne Aussicht auf Besserung. In diesen,
eigentlich aussichtslosen Situationen können Keratoprothesen häufig sehr
schnelle und erstaunliche Sehverbesserungen erzielen, die aber mit einem hohen
Risiko für schwerwiegende Komplikationen erkauft werden.
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Yuan X, Zhang J. Real-Time Monitoring of Intraocular Pressure in Glaucoma Patients Using Wearable Mobile Medicine Devices. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2271937. [PMID: 35388317 PMCID: PMC8979698 DOI: 10.1155/2022/2271937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
Glaucoma is caused by excessive aqueous humor in the eye, resulting in a continuous or intermittent increase of intraocular pressure, which exceeds the tolerance of the eyeball and damages the optic nerve. Existing treatments for glaucoma do not work well or have significant side effects. Intraocular pressure signal is a very important physiological signal that needs real-time and accurate monitoring in glaucoma patients, especially in severe glaucoma patients. Therefore, long-term, real-time, and accurate monitoring of intraocular pressure is of great significance for the diagnosis and treatment of glaucoma patients. The use of wearable devices for real-time ocular diagnosis and treatment of glaucoma patients is an effective approach. However, the current commonly used intraocular pressure measurement and monitoring technology is difficult to meet the diagnosis and monitoring needs of glaucoma patients in terms of size, measurement accuracy, power consumption, and intelligence. Therefore, facing the needs of glaucoma disease treatment, this topic studies an implantable flexible intraocular pressure sensor for long-term continuous monitoring of intraocular pressure in glaucoma patients and mainly focuses on the working principle, structural design, process fabrication, measurement and control system, characterization, and performance test of the intraocular pressure sensor. It is of great significance for personalized and accurate treatment of glaucoma patients.
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Affiliation(s)
- Xiangwen Yuan
- Department of Ophthalmology, Jinan People's Hospital Shandong, Jinan 271100, China
| | - Jiabin Zhang
- Department of Ophthalmology, Jinan People's Hospital Shandong, Jinan 271100, China
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Geoffrion D, Hassanaly SI, Marchand M, Daoud R, Agoumi Y, Harissi-Dagher M. Assessment of the Role and Timing of Glaucoma Surgery in Boston Keratoprosthesis Type 1 Patients. Am J Ophthalmol 2022; 235:249-257. [PMID: 34543660 DOI: 10.1016/j.ajo.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the role and optimal timing of glaucoma surgery in relation to Boston keratoprosthesis type 1 (KPro) implantation. DESIGN Retrospective, comparative, nonrandomized clinical study. METHODS Single-center study of a total of 100 eyes (100 patients) implanted with a KPro between 2008 and 2017, and diagnosed with glaucoma before or after KPro. Patients were separated into 2 groups: those with preexisting glaucoma and those who developed de novo glaucoma after KPro. Groups were then divided based on whether patients were medically or surgically managed. Glaucoma surgery included glaucoma drainage device (GDD) implantation, trabeculectomy, and cyclophotocoagulation (CPC). Primary outcomes included best-corrected visual acuity (BCVA), glaucoma progression, and complications. Differences in outcomes were compared using parametric and nonparametric tests, as well as log-rank test to compare time-to-outcome events. RESULTS Among 72 eyes with preexisting glaucoma, 27 (38%) had glaucoma surgery before KPro (18 GDD), whereas 45 (62%) were medically managed only. Among the latter, 19 (42%) needed glaucoma surgery post-KPro (16 GDD). Among 28 eyes with de novo glaucoma, 12 (43%) had glaucoma surgery post-KPro (9 GDD). For eyes with preexisting glaucoma, glaucoma progression was greater with glaucoma surgery performed post-KPro (100%) compared with pre-KPro (74%, P = .016) and to medical management (54%, P = .002). No increase in complications were observed with glaucoma surgery compared to medications only (P > .05), whereas fewer eyes maintained a BCVA of 20/200 or better over time with medical management (P = .013). Eyes with de novo glaucoma had similar progression, BCVA, and complications between medical and surgical care (P > .05). CONCLUSIONS Glaucoma surgery should be performed before or at the same time as KPro implantation in eyes with preexisting glaucoma. Complication rates are not increased when glaucoma surgery is performed in KPro eyes with either preexisting or de novo glaucoma. To ensure optimal glaucoma control, glaucoma surgery should be performed as early as possible in KPro eyes with good visual potential.
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Affiliation(s)
- Dominique Geoffrion
- From the Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM) (D.G., S.I.H., M.M., R.D., Y.A., M.H.-D.), Montreal, Quebec, Canada; Department of Experimental Surgery, Faculty of Medicine, McGill University (D.G.), Montreal, Quebec, Canada
| | - Salima I Hassanaly
- Department of Ophthalmology & Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago (S.I.H.), Chicago, Illinois, USA
| | - Michael Marchand
- From the Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM) (D.G., S.I.H., M.M., R.D., Y.A., M.H.-D.), Montreal, Quebec, Canada
| | - Roy Daoud
- From the Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM) (D.G., S.I.H., M.M., R.D., Y.A., M.H.-D.), Montreal, Quebec, Canada
| | - Younes Agoumi
- From the Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM) (D.G., S.I.H., M.M., R.D., Y.A., M.H.-D.), Montreal, Quebec, Canada
| | - Mona Harissi-Dagher
- From the Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM) (D.G., S.I.H., M.M., R.D., Y.A., M.H.-D.), Montreal, Quebec, Canada.
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AlHilali SM, Al-Swailem SA. Challenges of Glaucoma Management in Patients with Type I Boston Keratoprosthesis. Clin Ophthalmol 2022; 16:369-374. [PMID: 35177895 PMCID: PMC8846611 DOI: 10.2147/opth.s349719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022] Open
Abstract
Type I Boston keratoprosthesis is implanted in patients with severely diseased eyes who are considered poor candidates for traditional keratoplasty. Glaucoma is considered a major visual comorbidity following the implantation of type I Boston keratoprosthesis (KPro). Eyes that receive a Boston KPro are at high risk of progression of pre-existing glaucoma and the development of de novo glaucoma. Both complications can limit best-corrected visual acuity postoperatively. Diagnosis and surveillance for glaucoma in KPro eyes are fundamental to mitigate the risk of visual morbidity. However, managing these patients presents several challenges. The diagnosis of glaucoma after KPro implantation is usually hindered by inaccurate intraocular pressure (IOP) measurements and unreliable ophthalmic investigations such as visual field testing and optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL). In these eyes, medical management of glaucoma with topical medications is usually insufficient, and glaucoma surgery is usually warranted either prior to or during KPro implantation. Options for glaucoma surgery include glaucoma drainage device (GDD) and cyclodestructive procedures. The aim of this article is to highlight the incidence, pathophysiology, diagnosis, and management options of glaucoma in eyes that have undergone type I Boston keratoprosthesis.
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Affiliation(s)
- Sara M AlHilali
- Cornea, External Eye Diseases and Refractive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Samar A Al-Swailem
- Cornea, External Eye Diseases and Refractive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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13
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The Historical Development and an Overview of Contemporary Keratoprostheses. Surv Ophthalmol 2022; 67:1175-1199. [DOI: 10.1016/j.survophthal.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
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Retinal Detachment in Eyes with Boston Type 1 Keratoprosthesis: Surgical Techniques and Mid-Term Outcomes. Retina 2021; 42:957-966. [PMID: 34954778 DOI: 10.1097/iae.0000000000003389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the mid-term outcomes of pars plana vitrectomy (PPV) performed for retinal detachment (RD) repair after Boston type 1 keratoprosthesis (KPro) implantation. METHODS Retrospective chart review of KPro implanted at the Stein Eye Institute presenting with RD and treated by PPV. Functional success was defined as a postoperative visual acuity (VA) maintained within 2 Snellen lines of the CDVA measured before the development of the RD (baseline) and anatomical success as an attached retina after the PPV. Kaplan-Meyer survival analyses were performed. RESULTS Among the 224 KPro performed, 28 (15.2%) RD were identified, of which 21 (9.4%) were included. The mean follow-up was 42.5 ± 27.3 months. Vitreoretinal proliferation was present in 18/21 (85.7%) eyes. Surgical techniques were adapted to the complex anterior segment anatomy of KPro eyes. Anatomical success was achieved in 18/21 (85.7%) eyes. Functional success occurred in 17/21 (81.0%) eyes, and 5/21 (23.8%) eyes reached 20/400 or better VA at final follow-up. The KPro was retained in 11/21 (52.4%) eyes. The retention rate decreased from 94.7% at 1 year to 53.5% at 5 years. The most frequent complications were retroprosthetic membrane (47.6%) and corneal melt (23.8%). CONCLUSION Modified PPV techniques resulted in relatively good mid-term anatomic, functional, and retention rate outcomes, given the severity of RD at presentation, and the numerous preoperative comorbidities of KPro eyes.
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Wong SH, Tsai JC. Telehealth and Screening Strategies in the Diagnosis and Management of Glaucoma. J Clin Med 2021; 10:jcm10163452. [PMID: 34441748 PMCID: PMC8396962 DOI: 10.3390/jcm10163452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
Telehealth has become a viable option for glaucoma screening and glaucoma monitoring due to advances in technology. The ability to measure intraocular pressure without an anesthetic and to take optic nerve photographs without pharmacologic pupillary dilation using portable equipment have allowed glaucoma screening programs to generate enough data for assessment. At home, patients can perform visual acuity testing, web-based visual field testing, rebound tonometry, and video visits with the physician to monitor for glaucomatous progression. Artificial intelligence will enhance the accuracy of data interpretation and inspire confidence in popularizing telehealth for glaucoma.
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Schaub F, Matthaei M, Enders P, Siebelmann S, Hos D, Bachmann BO, Cursiefen C. [Treatment of vascularized high-risk eyes with a Boston keratoprosthesis]. Ophthalmologe 2021; 118:544-552. [PMID: 33730307 DOI: 10.1007/s00347-021-01356-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In severely compromised and vascularized high-risk eyes, the Boston keratoprosthesis procedure is often the last treatment option. The transparency of the optics is not impaired by endothelial immune reactions. METHODS This review article discusses relevant literature as well as our own data and experiences with the Boston keratoprosthesis in high-risk eyes. The relevant complications as well as the postoperative management are discussed. RESULTS In more than 60% of the high-risk eyes a long-term increase in visual acuity can be achieved. Keratoprosthesis retention rates show a variable span with reported mean 5‑year retention rates of 75%. The most common postoperative complications include the formation of a retroprosthetic membrane and keratolysis in up to 50% each. More than 70% of the eyes already suffer from (secondary) glaucoma preoperatively, so that glaucoma surgery is performed simultaneously in at least 20% of cases and in the postoperative course further antiglaucomatous surgery is necessary in up to 31%. Vitreoretinal complications include, in particular, sterile vitritis and infectious endophthalmitis but persistent hypotonia is also described in one third of patients. CONCLUSION The Boston keratoprosthesis is an alternative to conventional corneal replacement if the prognosis for allogeneic transplants is poor. Postoperative complications are common; therefore, postoperative management plays an important role. For vascularized high-risk eyes, however, it is often the only remaining option for visual rehabilitation.
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Affiliation(s)
- F Schaub
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
| | - M Matthaei
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - P Enders
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Glaucoma Imaging Center University of Cologne, Medizinische Fakultät, Universitätsklinik Köln, Köln, Deutschland
| | - S Siebelmann
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - D Hos
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Zentrum für Molekulare Medizin Köln, Universität zu Köln, Köln, Deutschland
| | - B O Bachmann
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - C Cursiefen
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Zentrum für Molekulare Medizin Köln, Universität zu Köln, Köln, Deutschland
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Raber FP, Gerbutavicius R, Wolf A, Kortüm K. Smartphone-Based Data Collection in Ophthalmology. Klin Monbl Augenheilkd 2020; 237:1420-1428. [PMID: 33285587 DOI: 10.1055/a-1232-4250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Due to their widespread use among the population and their wide range of functions and sensors, smartphones are suitable for data collection for medical purposes. App-supported input masks, patient diaries, and patient information systems, mobile access to the patient file as well as telemedical services will continue to find their way into our field of expertise in the future. In addition, the use of smartphone sensors (GPS and motion sensors, touch display, microphone) and coupling possibilities with biosensors (for example with Continuous Glucose Monitoring [CGM] systems), advanced camera technology, the possibility of regular and appointment independent checking of the visual system (visual acuity/contrast vision) as well as real-time data transfer offer interesting possibilities for patient treatment and clinical research. The present review deals with the current status and future perspectives of smartphone-based data collection and possible applications in ophthalmology.
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Affiliation(s)
| | | | - Armin Wolf
- Augenklinik, Universitätsklinikum Ulm, Deutschland
| | - Karsten Kortüm
- Augenheilkunde, Augenarztpraxis Dres. Kortüm, Ludwigsburg, Deutschland.,Augenklinik, Ludwig-Maximilians-Universität München, Medizinische Fakultät, München, Deutschland
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[Dependency of intraocular pressure on body posture in glaucoma patients : New approaches to pathogenesis and treatment]. Ophthalmologe 2020; 117:730-739. [PMID: 32399617 DOI: 10.1007/s00347-020-01113-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKROUND Human intraocular pressure (IOP) depends on the position of the head in relation to the body in space. Physiologically, the IOP increases in a lying position compared to an upright posture. Microgravity in space also appears to cause an increase in intraocular pressure, accompanied by other ophthalmological changes, which are summarized under the term spaceflight associated neuro-ocular syndrome (SANS). Bed rest studies are being carried out to investigate the effects of weightlessness on the human body. So here there is an intersection between research into SANS and glaucoma. Increased intraocular pressure remains the most important risk factor for glaucoma development and progression that can be influenced by treatment. The influence of position-dependent IOP fluctuations on glaucoma is still not sufficiently understood. MATERIALS AND METHODS A literature search was carried in PubMed on the subject of IOP fluctuations related to posture. Analysis and evaluation of the published study results and a summary of available clinical data. RESULTS The increase in IOP when changing from a seated to a lying body position is greater in glaucoma patients with an increase of up to 8.6 mm Hg compared to healthy subjects with an increase up to 5 mm Hg. In small pilot studies the increase in lying IOP in some glaucoma patients and healthy volunteers could be attenuated by elevation of the head by 30%. A lower compartmental pressure in the subarachnoid space has been associated with glaucoma and may represent a risk factor for glaucoma development. Not only the level of IOP but also IOP fluctuations were associated with an increased risk of disease progression. CONCLUSION The clinical significance of IOP peaks during sleep on glaucoma is still not sufficiently understood. New methods for continuous IOP measurement offer promising opportunities for further research into the importance of IOP fluctuations related to changes of body and head posture.
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Short-term Interim Results of Clinical Outcomes and Complications After Implantation of Boston Keratoprosthesis in Japanese Patients. Cornea 2020; 39 Suppl 1:S28-S33. [DOI: 10.1097/ico.0000000000002453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Invernizzi A, Haykal S, Lo Faro V, Pennisi V, Choritz L. Influence of electromagnetic radiation emitted by daily-use electronic devices on the Eyemate® system in-vitro: a feasibility study. BMC Ophthalmol 2020; 20:357. [PMID: 32867712 PMCID: PMC7461327 DOI: 10.1186/s12886-020-01623-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eyemate® is a system for the continual monitoring of intraocular pressure (IOP), composed of an intraocular sensor, and a hand-held reader device. As the eyemate®-IO sensor communicates with the hand-held reader telemetrically, some patients might fear that the electronic devices that they use on a daily basis might somehow interfere with this communication, leading to unreliable measurements of IOP. In this study, we investigated the effect of electromagnetic radiation produced by a number of everyday electronic devices on the measurements made by an eyemate®-IO sensor in-vitro, in an artificial and controlled environment. METHODS The eyemate®-IO sensor was suspended in a sterile 0.9% sodium chloride solution and placed in a water bath at 37 °C. The antenna, connected to a laptop for recording the data, was positioned at a fixed distance of 1 cm from the sensor. Approximately 2 hrs of "quasi-continuous" measurements were recorded for the baseline and for a cordless phone, a smart-phone and a laptop. Repeated measures ANOVA was used to compare any possible differences between the baseline and the tested devices. RESULTS For baseline measurements, the sensor maintained a steady-state, resulting in a flat profile at a mean pressure reading of 0.795 ± 0.45 hPa, with no apparent drift. No statistically significant difference (p = 0.332) was found between the fluctuations in the baseline and the tested devices (phone: 0.76 ± 0.41 hPa; cordless: 0.787 ± 0.26 hPa; laptop: 0.775 ± 0.39 hPa). CONCLUSION In our in-vitro environment, we found no evidence of signal drifts or fluctuations associated with the tested devices, thus showing a lack of electromagnetic interference with data transmission in the tested frequency ranges.
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Affiliation(s)
- Azzurra Invernizzi
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands.
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands.
| | - Shereif Haykal
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Valeria Lo Faro
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands
| | - Vincenzo Pennisi
- Department of Ophthalmology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Lars Choritz
- Department of Ophthalmology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
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Enders P, Cursiefen C. Device profile of the EYEMATE-IO™ system for intraocular pressure monitoring: overview of its safety and efficacy. Expert Rev Med Devices 2020; 17:491-497. [DOI: 10.1080/17434440.2020.1761788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Philip Enders
- Department of Ophthalmology, University Hospital of Cologne , Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University Hospital of Cologne , Cologne, Germany
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Perucho-González L, García-Feijoó J. Evaluation and treatment of glaucoma 24hours a day. Where are we and where are we going? ACTA ACUST UNITED AC 2020; 95:345-352. [PMID: 32345482 DOI: 10.1016/j.oftal.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/26/2022]
Abstract
Current management of glaucoma generally involves medical, laser, or surgical treatment in order to achieve an intraocular pressure (IOP) control which is commensurate with either stability or delayed progression of the disease. Although the follow-up of glaucoma patients is usually carried out with sporadic and isolated intraocular pressure measurements, the literature already indicates that this might not the best option to manage glaucoma patients. This article reviews the importance of 24hours intraocular pressure monitoring based on studies and publications that exist in this regard to date. A critical review on the methodology of these publications has been conducted. The need is stressed for further studies on the intraocular pressure patterns in different types of glaucoma, as well as the pattern with different therapies used in glaucoma aimed at optimising the management of the disease.
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Affiliation(s)
- L Perucho-González
- Fundación para la Investigación Biomédica, Hospital Clínico San Carlos, IdISSC, Departamento de Oftalmología, Universidad Complutense de Madrid, RETICS, Madrid, España.
| | - J García-Feijoó
- Fundación para la Investigación Biomédica, Hospital Clínico San Carlos, IdISSC, Departamento de Oftalmología, Universidad Complutense de Madrid, RETICS, Madrid, España
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Gillmann K, Bravetti GE, Niegowski LJ, Mansouri K. Using sensors to estimate intraocular pressure: a review of intraocular pressure telemetry in clinical practice. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1681264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kevin Gillmann
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | | | | | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA
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