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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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Soh YQ, Kocaba V, Weiss JS, Jurkunas UV, Kinoshita S, Aldave AJ, Mehta JS. Corneal dystrophies. Nat Rev Dis Primers 2020; 6:46. [PMID: 32528047 DOI: 10.1038/s41572-020-0178-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 12/21/2022]
Abstract
Corneal dystrophies are broadly defined as inherited disorders that affect any layer of the cornea and are usually progressive, bilateral conditions that do not have systemic effects. The 2015 International Classification of Corneal Dystrophies classifies corneal dystrophies into four classes: epithelial and subepithelial dystrophies, epithelial-stromal TGFBI dystrophies, stromal dystrophies and endothelial dystrophies. Whereas some corneal dystrophies may result in few or mild symptoms and morbidity throughout a patient's lifetime, others may progress and eventually result in substantial visual and ocular disturbances that require medical or surgical intervention. Corneal transplantation, either with full-thickness or partial-thickness donor tissue, may be indicated for patients with advanced corneal dystrophies. Although corneal transplantation techniques have improved considerably over the past two decades, these surgeries are still associated with postoperative risks of disease recurrence, graft failure and other complications that may result in blindness. In addition, a global shortage of cadaveric corneal graft tissue critically limits accessibility to corneal transplantation in some parts of the world. Ongoing advances in gene therapy, regenerative therapy and cell augmentation therapy may eventually result in the development of alternative, novel treatments for corneal dystrophies, which may substantially improve the quality of life of patients with these disorders.
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Affiliation(s)
- Yu Qiang Soh
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore.,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Viridiana Kocaba
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands
| | - Jayne S Weiss
- Department of Ophthalmology, Pathology and Pharmacology, Louisiana State University, School of Medicine, New Orleans, USA
| | - Ula V Jurkunas
- Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Schepens Eye Research Institute, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Anthony J Aldave
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore. .,Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore. .,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore.
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