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Yang Z, Wang YQ, Wang Q, Xu W, Zhang S, Li Z, Huang Y, Huang YF, Wang LQ. Causes of Corneal Melt After the Boston Keratoprosthesis Type I: The Chinese People's Liberation Army General Hospital Experience. Cornea 2024; 43:936-941. [PMID: 38713491 DOI: 10.1097/ico.0000000000003563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/17/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the long-term incidence, risk factors, and the management of corneal melt following Boston type I keratoprosthesis (B-KPro I) implantation. METHODS This is a retrospective observational case series. Data were collected regarding demographics, preoperative characteristics, incidence, and outcomes of corneal melt in 102 patients who underwent B-KPro I in the Chinese PLA General Hospital between 2011 and 2018, with a follow-up period ranging from 4 to 11 years. RESULTS Chemical burn was the most common indication for B-KPro I (n = 56; 53.8%), followed by ocular trauma (n = 26; 25.0%). During the follow-up period (107 ± 25.7 months), corneal melt occurred in 60 cases among 37 eyes (35.6%), with an incidence of 20.2% at 1 year after surgery. Fourteen cases presented with recurrent corneal melt. Patients with multiple corneal allograft failures had a higher risk of corneal melt. Thermal burns, compared with alkali burns, significantly elevated the odds ratio (OR) of corneal melt (OR, 5.11; 95% confidence interval, 1.05-24.86; P = 0.043). CONCLUSIONS Corneal melt significantly reduced the retention time of KPro ( P < 0.01), and its coexistence with other complications further shortened the retention time. A specific pattern of corneal melt occurrence was identified, with a peak incidence at 1 year postoperatively. Our findings suggest variations in the risk of corneal melt among different indications, with thermal burns carrying the highest OR. Moreover, each previous failed keratoplasty doubled the risk of corneal melt after B-KPro I.
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Affiliation(s)
- Zhe Yang
- Medical School of Chinese PLA, Beijing, China
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
| | - Yu-Qi Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
- School of Medicine, Nankai University, Tianjin, China
| | - Qun Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
| | - Weiwei Xu
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
| | - Shifeng Zhang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
- School of Medicine, Nankai University, Tianjin, China
| | - Zhao Li
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
- School of Medicine, Nankai University, Tianjin, China
| | - Yulei Huang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
- School of Medicine, Nankai University, Tianjin, China
| | - Yi-Fei Huang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
| | - Li-Qiang Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China ; and
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Thirunavukarasu AJ, Morales-Wong F, Halim NSH, Han E, Koh SK, Zhou L, Kocaba V, Venkatraman S, Mehta JS, Riau AK. Nanohydroxyapatite Coating Attenuates Fibrotic and Immune Responses to Promote Keratoprosthesis Biointegration in Advanced Ocular Surface Disorders. ACS APPLIED MATERIALS & INTERFACES 2024; 16:25892-25908. [PMID: 38740379 PMCID: PMC11129699 DOI: 10.1021/acsami.4c04077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
Keratoprosthesis (KPro) implantation is frequently the only recourse for patients with severe corneal disease. However, problems arise due to inadequate biointegration of the KPro, particularly the PMMA optical cylinder, such as tissue detachment, tissue melting, or eye-threatening infection in the interface. Here, using the AuroKPro as a model prosthesis, a surface functionalization approach─coating the optical cylinder with nanohydroxyapatite (nHAp)─was trialed in rabbit eyes with and without a proceeding chemical injury. In chemically injured eyes, which simulated total limbal epithelial stem cell deficiency, clear benefits were conferred by the coating. The total modified Hackett-McDonald score and area of tissue apposition differences 12 weeks after implantation were 5.0 and 22.5%, respectively. Mechanical push-in tests revealed that 31.8% greater work was required to detach the tissues. These differences were less marked in uninjured eyes, which showed total score and tissue apposition differences of 2.5 and 11.5%, respectively, and a work difference of 23.5%. The improved biointegration could be contributed by the attenuated expression of fibronectin (p = 0.036), collagen 3A1 (p = 0.033), and α-smooth muscle actin (p = 0.045)─proteins typically upregulated during nonadherent fibrous capsule envelopment of bioinert material─adjacent to the optical cylinders. The coating also appeared to induce a less immunogenic milieu in the ocular surface tissue, evidenced by the markedly lower expression of tear proteins associated with immune and stimulus responses. Collectively, the level of these tear proteins in eyes with coated prostheses was 1.1 ± 13.0% of naïve eyes: substantially lower than with noncoated KPros (246.5 ± 79.3% of naïve, p = 0.038). Together, our results indicated that nHAp coating may reduce the risk of prosthesis failure in severely injured eyes, which are representative of the cohort of KPro patients.
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Affiliation(s)
- Arun J. Thirunavukarasu
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
- Oxford
University Clinical Academic Graduate School, University of Oxford, Oxford OX3 9DU, United
Kingdom
| | - Fernando Morales-Wong
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
- Singapore
National Eye Centre, Singapore 168751, Singapore
- Autonomous
University of Nuevo Leon, San Nicolas
de los Garza, Nuevo Leon 66455, Mexico
| | | | - Evelina Han
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
| | - Siew Kwan Koh
- Ocular
Proteomics Group, Singapore Eye Research
Institute, Singapore 169856, Singapore
| | - Lei Zhou
- Department
of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Centre
for Eye and Vision Research, Shatin, Hong Kong
| | - Viridiana Kocaba
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
| | - Subramanian Venkatraman
- Department
of Materials Science and Engineering, National
University of Singapore, Singapore 117575, Singapore
- iHealthTech, National University of Singapore, Singapore 117599, Singapore
| | - Jodhbir S. Mehta
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
- Singapore
National Eye Centre, Singapore 168751, Singapore
- Ophthalmology
and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Andri K. Riau
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
- Ophthalmology
and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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Chandran C, Santra M, Rubin E, Geary ML, Yam GHF. Regenerative Therapy for Corneal Scarring Disorders. Biomedicines 2024; 12:649. [PMID: 38540264 PMCID: PMC10967722 DOI: 10.3390/biomedicines12030649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 05/09/2024] Open
Abstract
The cornea is a transparent and vitally multifaceted component of the eye, playing a pivotal role in vision and ocular health. It has primary refractive and protective functions. Typical corneal dysfunctions include opacities and deformities that result from injuries, infections, or other medical conditions. These can significantly impair vision. The conventional challenges in managing corneal ailments include the limited regenerative capacity (except corneal epithelium), immune response after donor tissue transplantation, a risk of long-term graft rejection, and the global shortage of transplantable donor materials. This review delves into the intricate composition of the cornea, the landscape of corneal regeneration, and the multifaceted repercussions of scar-related pathologies. It will elucidate the etiology and types of dysfunctions, assess current treatments and their limitations, and explore the potential of regenerative therapy that has emerged in both in vivo and clinical trials. This review will shed light on existing gaps in corneal disorder management and discuss the feasibility and challenges of advancing regenerative therapies for corneal stromal scarring.
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Affiliation(s)
- Christine Chandran
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
| | - Mithun Santra
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
| | - Elizabeth Rubin
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
| | - Moira L. Geary
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
| | - Gary Hin-Fai Yam
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
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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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Mahuvakar S, Jain N, Basu S. Successful use of conjunctival flaps to prolong survival of type I keratoprosthesis in severe bilateral chemical burns: two case reports. F1000Res 2023; 12:521. [PMID: 37920455 PMCID: PMC10618640 DOI: 10.12688/f1000research.131492.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION This report describes the use of conjunctival flaps to enable the survival of type I keratoprosthesis (KPro) in two cases of bilateral severe total limbal stem cell deficiency (LSCD) following chemical burns. PRESENTATION OF CASE Two patients had a history of bilateral chemical injury with lime. On examination, the presenting vision was light perception to hand motions and both cases had conjunctivalized ocular surfaces with symblepharon. A modified technique of type I keratoprosthesis was used, where the conjunctivalized corneal pannus was dissected and lifted off as an inferior fornix-based conjunctival flap. This was followed by a standard surgical technique of type I KPro. The flap was then secured over the device and optical opening was made two weeks later. Both the patients had stable ocular surfaces with visual acuity of 20/20 at 2-7 years of follow-up. DISCUSSION In patients with total LSCD with adnexal involvement, type I KPro has unsatisfactory long-term survival because of the risk of repeated epithelial breakdowns and stromal ulceration. With the innovative approach described in this report, type I KPro can be successfully used for sustainable visual improvement in the presence of severe ocular surface disease and symblepharon. CONCLUSION Conjunctival flaps can be used along with type I KPros to improve long-term survival and give sustainable visual outcomes in cases of bilateral corneal blindness due to advanced ocular surface damage.
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Affiliation(s)
- Sheetal Mahuvakar
- Cornea and Refractive Services, Dr. Nagpal's Retina Foundation, Ahmedabad, Gujarat, India
| | - Neha Jain
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
- Prof. Brien Holden Eye Research Centre (BHERC), LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
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Anatomical and functional outcomes of Boston type I keratoprosthesis as primary penetrating corneal procedure in high-risk and non-high-risk cases. Graefes Arch Clin Exp Ophthalmol 2023; 261:161-170. [PMID: 35857089 DOI: 10.1007/s00417-022-05744-0] [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: 03/27/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To analyze the anatomical and functional results of Boston type I keratoprosthesis (B1-KPro) as a primary corneal procedure in high-risk (HR) cases and non-high-risk (NHR) cases. METHODS In this retrospective interventional case series, all patients who underwent B1-KPro at a single center between January 2006 and March 2021 were reviewed and identified. Cases were classified according to the primary diagnosis. Anatomical failure was considered in the case of prosthesis extrusion or phthisis bulbi. Functional failure was a postoperative corrected distance visual acuity (CDVA) ≥ 1.3 LogMAR (≤ 0.05 decimal) at the end of the follow-up period. RESULTS Twenty-three eyes were included for analysis. Thirteen eyes were classified as HR and 10 as NHR. The mean age was 46.5 ± 26.5 years (5-84 years) in the HR group and 49.5 ± 26.9 years (2-78 years) in the NHR group. The mean follow-up was 42.0 ± 35.9 months (1.5-118 months) in HR and 44.8 ± 38.8 months (1-107 months) in NHR. Three eyes in the HR and none in the NHR group showed anatomical failure. Functional failure was reported in 5/13 eyes in the HR and 8/10 in the NHR group. Functional cumulative survival probability was 92% and 82% for the HR group at 1 and 2 years, respectively. In the NHR group, it was 27% at both times. No significant differences were found between groups, except for functional survival in the HR group due to better visual potential of the eyes. CONCLUSIONS B1-KPro as a primary corneal procedure is a valid option for visual rehabilitation in high-risk cases.
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Salvador-Culla B, Hogg J, Okonkwo A, Mulroy J, Figueiredo GS, Figueiredo FC. Severe chemical eye injuries - clinical outcomes and associated socio-economic factors. Scars Burn Heal 2023; 9:20595131231180367. [PMID: 37781443 PMCID: PMC10536839 DOI: 10.1177/20595131231180367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Aims To describe clinical outcomes, management, and socio-economic impact of severe acute chemical eye injuries in a tertiary hospital. Methods 37 patients required emergency admission to the Royal Victoria Infirmary eye ward between April 2013 and September 2015. Demographics, best corrected distance visual acuity (BCDVA), causative agent, degree of limbal stem cell deficiency (LSCD), management and socio-economic data were evaluated. Results Mean age on admission was 34.5 years (SD 16.3; range 16-82); 30 males (81.1%); 22 bilateral (59.5%). Causative agent: alkali in 30 cases (81.1%); acid in three cases (8.1%); and unknown in four cases (10.8%). Fifteen cases (40.5%) were assaults, 12 (32.5%) work-related accidents, nine (24.3%) domestic accidents and one (2.7%) undetermined. Eleven patients (29.7%) were unemployed, 18 (48.6%) were labourers, three (8.1%) were students, three (8.1%) were retired and two (5.4%) were professionals. Mean admission time was five days (SD 3.2; range 1-12). Mean follow-up time was 170.5 days (range 1-946). Mean cost of admission was £2478 (range £274-5785). Five patients (13%; seven eyes) developed total or partial limbal stem cell deficiency, all being assaults. Conclusions Main causative agent in our study was alkali, with young men in the working age being most frequently involved. Many patients required prolonged hospital admission and costly follow-up. The majority of cases were assaults, mostly occurring in unemployed patients. All the limbal stem cell deficiency cases were due to assaults. We believe that socio-economic factors play an important role in the cause, severity and cost of chemical eye injuries. Lay Summary Acute chemical eye injuries have a significant and extensive impact on patients' visual function outcomes and vision-related quality of life, with consequent enormous burden to affected individuals, their families and society. We believe that by understanding the socio-economic environment, we may not only be able to enforce safety measures to tackle the increasing rate of severe chemical eye injuries in our community, but also to develop collaborative programmes with the community, educating the population on the seriousness of chemical eye injuries, and with the local authorities, trying to understand the clustering of assaults in areas and tackling the associated socio-economic risk factors, such as unemployment. Given the increasing rate of assaults using chemicals in recent times, it is also important to assess availability of adequate victim support programmes and develop good interaction with relevant local, regional and national authorities to ensure all aspects of community security service are in place to be able to address any potential deficiencies in line with police and home office guidelines. Keeping in mind that the best action plan is always prevention. However, when an ocular injury does occur it is evident that significant morbidity and visual sequelae can result and affect the socio-economic status of the victims despite our best current medical and surgical care.
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Affiliation(s)
| | - Jeffrey Hogg
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Arthur Okonkwo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Julie Mulroy
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Francisco C. Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Bioscience Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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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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Sánchez-Ávila RM, Vázquez N, Chacón M, Persinal-Medina M, Brea-Pastor A, Berisa-Prado S, Fernández-Vega-Cueto L, Anitua E, Meana Á, Merayo-Lloves J. Fibrin-Plasma Rich in Growth Factors Membrane for the Treatment of a Rabbit Alkali-Burn Lesion. Int J Mol Sci 2021; 22:ijms22115564. [PMID: 34070266 PMCID: PMC8197415 DOI: 10.3390/ijms22115564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this work is to describe the use of Fibrin-Plasma Rich in Growth Factors (PRGF) membranes for the treatment of a rabbit alkali-burn lesion. For this purpose, an alkali-burn lesion was induced in 15 rabbits. A week later, clinical events were evaluated and rabbits were divided into five treatment groups: rabbits treated with medical treatment, with a fibrin-PRGF membrane cultured with autologous or heterologous rabbit Limbal Epithelial Progenitor Cells (LEPCs), with a fibrin-PRGF membrane in a Simple Limbal Epithelial Transplantation and with a fibrin-PRGF membrane without cultured LEPCs. After 40 days of follow-up, corneas were subjected to histochemical examination and immunostaining against corneal or conjunctival markers. Seven days after alkali-burn lesion, it was observed that rabbits showed opaque cornea, new blood vessels across the limbus penetrating the cornea and epithelial defects. At the end of the follow-up period, an improvement of the clinical parameters analyzed was observed in transplanted rabbits. However, only rabbits transplanted with cultured LEPCs were positive for corneal markers. Otherwise, rabbits in the other three groups showed positive staining against conjunctival markers. In conclusion, fibrin-PRGF membrane improved the chemically induced lesions. Nonetheless, only fibrin-PRGF membranes cultured with rabbit LEPCs were able to restore the corneal surface.
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Affiliation(s)
- Ronald M. Sánchez-Ávila
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33071 Oviedo, Spain; (R.M.S.-Á.); (N.V.); (M.C.); (M.P.-M.); (S.B.-P.); (L.F.-V.-C.); (J.M.-L.)
- Biotechnology Institute (BTI), 01007 Vitoria, Spain;
| | - Natalia Vázquez
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33071 Oviedo, Spain; (R.M.S.-Á.); (N.V.); (M.C.); (M.P.-M.); (S.B.-P.); (L.F.-V.-C.); (J.M.-L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33071 Oviedo, Spain
| | - Manuel Chacón
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33071 Oviedo, Spain; (R.M.S.-Á.); (N.V.); (M.C.); (M.P.-M.); (S.B.-P.); (L.F.-V.-C.); (J.M.-L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33071 Oviedo, Spain
| | - Mairobi Persinal-Medina
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33071 Oviedo, Spain; (R.M.S.-Á.); (N.V.); (M.C.); (M.P.-M.); (S.B.-P.); (L.F.-V.-C.); (J.M.-L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33071 Oviedo, Spain
| | - Agustín Brea-Pastor
- Unidad de Bioterio e imagen Preclínica, Universidad de Oviedo, 33071 Oviedo, Spain;
| | - Silvia Berisa-Prado
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33071 Oviedo, Spain; (R.M.S.-Á.); (N.V.); (M.C.); (M.P.-M.); (S.B.-P.); (L.F.-V.-C.); (J.M.-L.)
| | - Luis Fernández-Vega-Cueto
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33071 Oviedo, Spain; (R.M.S.-Á.); (N.V.); (M.C.); (M.P.-M.); (S.B.-P.); (L.F.-V.-C.); (J.M.-L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33071 Oviedo, Spain
| | - Eduardo Anitua
- Biotechnology Institute (BTI), 01007 Vitoria, Spain;
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), 01007 Vitoria, Spain
| | - Álvaro Meana
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33071 Oviedo, Spain; (R.M.S.-Á.); (N.V.); (M.C.); (M.P.-M.); (S.B.-P.); (L.F.-V.-C.); (J.M.-L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33071 Oviedo, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (U714), ISCII, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-985-240-141; Fax: +34-985-233-288
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33071 Oviedo, Spain; (R.M.S.-Á.); (N.V.); (M.C.); (M.P.-M.); (S.B.-P.); (L.F.-V.-C.); (J.M.-L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33071 Oviedo, Spain
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Abstract
Purpose: To review the surgical management options in ocular chemical burn, including newer advances.Methods: Online literature search of published articles over last 5 years on surgical management of ocular chemical burn and newer advances were performed on December 30, 2020.Results: Following literature search and screening using adequate filters, 67 review articles on surgical management of ocular chemical burns were retrieved. The review talks about the surgical management options starting from Debridement in acute stage to various visual rehabilitative procedures in the chronic stage. The review also highlights the evolving surgical advances in this field.Conclusion: It is imperative to choose adequate surgical tool wherever applicable; current review discusses the role of each surgical option at different clinical stages in detail.
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Affiliation(s)
- Priyanshi Awasthi
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
| | - Prabhakar Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
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Wang LQ, Wu TY, Chen XN, Xu ZQ, Yang M, Xiang R, Ma X, Zhang S, Huang YF. Long-term outcomes of Boston keratoprosthesis type I: the Chinese People's Liberation Army General Hospital experience. Br J Ophthalmol 2021; 106:781-785. [PMID: 33674425 DOI: 10.1136/bjophthalmol-2019-315617] [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] [Received: 12/06/2019] [Revised: 10/22/2020] [Accepted: 01/19/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To report the long-term outcomes of Boston keratoprosthesis type I (B-KPro type I) implantation in the management of severe ocular surface disorders. METHODS Retrospective case series. Patients who underwent B-KPro type I implantation at the People's Liberation Army General Hospital were enrolled between March 2011 and September 2019. Data regarding visual acuity (VA), B-KPro type I retention and postoperative complications were recorded and analysed. RESULTS A total of 103 eyes of 100 patients who underwent B-KPro type I implantation were included. The main indications were chemical burn (59.2%), ocular trauma (25.2%), herpetic keratitis (11.7%) and autoimmune diseases (3.9%). The percentage of eyes with postoperative VA of 10/200 or better was 82.7% at 6 months, 82.8% at 12 months, 77.9% at 2 years, 72.4% at 3 years, 71.1% at 4 years, 69.4% at 5 years, 58.9% at 6 years, 56.8% at 7 years and 42.9% at 8 years. Preoperatively, 8.7% eyes were diagnosed with new-onset glaucoma. Retroprosthetic membrane formation occurred in 19.4% eye. Corneal melting occurred in 18.4% eyes. Sterile vitritis was diagnosed in 4.9% eyes and infectious endophthalmitis in 2.9% eyes. Retinal detachment occurred in 0.9% eyes. CONCLUSIONS In a Chinese patient group, B-KPro type I is a viable option for treating severe ocular surface disorders in eyes where conventional keratoplasty would have a poor prognosis, especially in patients with chemical and thermal burns. Improved visual outcomes and high retention rate can be achieved and maintained in most cases.
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Affiliation(s)
- Li-Qiang Wang
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Teng-Yun Wu
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China.,Department of Ophthalmology, Air Force Medical Center, Beijing, China
| | - Xiao-Niao Chen
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Ze-Quan Xu
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Min Yang
- Department of Ophthalmology, Chinese PLA 251 Hospital, Zhangjiakou, China
| | - Ran Xiang
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Xiao Ma
- Department of Ophthalmology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shan Zhang
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Yi-Fei Huang
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
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Nayman T, Bostan C, Szigiato AA, Harissi-Dagher M. Long-term outcomes following primary versus secondary Boston keratoprosthesis type 1 implantation. Br J Ophthalmol 2021; 106:935-940. [PMID: 33622700 DOI: 10.1136/bjophthalmol-2020-317606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/23/2020] [Accepted: 02/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To compare long-term outcomes of primary versus secondary (postgraft failure) Boston keratoprosthesis type 1 (KPro) implantation. METHODS Medical records of patients at the Centre hospitalier de l'Université de Montréal having undergone KPro implantation between 2008 and 2017 were reviewed and included if they had a preoperative Snellen best-corrected visual acuity (BCVA) of 20/100 or worse and a minimum of 5 years of follow-up. Eighty-two eyes were separated into two cohorts (40 primary, 42 secondary KPro) and BCVA, complications and device retention were evaluated between groups. RESULTS BCVA improved from baseline in both groups at each year; this was significant at all five postoperative years in the primary group and the first 3 years in the secondary group (p<0.05). Mean BCVA was similar between groups at 5 years (logarithm of minimal angle resolution 1.3±0.8 in the primary group vs 1.5±0.8 p<0.05). Idiopathic vitritis, choroidal detachment and new glaucoma occurred more after primary KPro (n=7, 17.5% vs n=1, 2.4%; n=11, 27.5% vs n=3, 7.14% and n=14, 35% vs n=6, 14%, respectively; p<0.05). Primary KPro had lower retention (n=28, 70% vs n=38, 91%, p<0.05) at final follow-up. There was more aniridia in the primary group (n=19, 48% vs n=6, 14%, p<0.01). Within each group, 50% of removals occurred in aniridic eyes. CONCLUSION Primary KPro yielded favourable long-term visual outcomes but had more complications and lower retention rates than secondary KPro, likely explained by preoperative indications. Primary device implantation represents a favourable option for patients for whom grafts are likely to fail.
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Affiliation(s)
- Taylor Nayman
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada .,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Cristina Bostan
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Andrei-Alexandru Szigiato
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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Shanbhag SS, Senthil S, Mohamed A, Basu S. Outcomes of the Boston type 1 and the Aurolab keratoprosthesis in eyes with limbal stem cell deficiency. Br J Ophthalmol 2020; 105:473-478. [PMID: 32554443 DOI: 10.1136/bjophthalmol-2020-316369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/28/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To analyse the outcomes of keratoprosthesis in eyes with limbal stem cell deficiency (LSCD) and to compare the outcomes in two different keratoprosthesis devices. METHODS This was a single-centre retrospective comparative case series which included 81 eyes of patients with severe bilateral corneal blindness secondary to LSCD. The patients underwent either Boston type 1 keratoprosthesis (Boston Kpro, n=44) or Aurolab keratoprosthesis (AuroKpro, n=37) implantation. The primary outcome measures of anatomical retention and functional recovery of 20/200 or better visual acuity at yearly time points until 5 years of follow-up were compared between the two groups. RESULTS The most common indication overall was chemical injury (64.2%). Anatomical retention rates were similar in the Boston Kpro (30/44, 68.2%) and AuroKpro (23/37, 62.2%) groups (p=0.89). Kaplan-Meier survival rates at 5 years of follow-up were greater for the Boston Kpro group with respect to both anatomical retention (58.51%±9% vs 43.8±12%; p=0.23) as well as functional recovery (42.61%±8% vs 35.03±10%; p=0.9); these differences were not statistically significant. Overall, the most common complication was new-onset glaucoma (59%; 48/81). The difference in incidence rate of this complication was not statistically significant among the two groups (p=0.09). CONCLUSION Keratoprosthesis is an effective treatment option for patients with corneal blindness secondary to LSCD. In a setting where LSCD is a common cause of corneal blindness, the AuroKpro, when available can be considered an alternative to the Boston Kpro to achieve anatomical and functional success in patients who otherwise would not have access to this device.
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Affiliation(s)
- Swapna S Shanbhag
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India .,Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India
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Nonpassopon M, Niparugs M, Cortina MS. Boston Type 1 Keratoprosthesis: Updated Perspectives. Clin Ophthalmol 2020; 14:1189-1200. [PMID: 32425503 PMCID: PMC7196770 DOI: 10.2147/opth.s219270] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022] Open
Abstract
The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.
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Affiliation(s)
- Manachai Nonpassopon
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Muanploy Niparugs
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Department of Ophthalmology, Faculty of Medicine, Chaing Mai University, Chaing Mai, Thailand
| | - Maria Soledad Cortina
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Systematic Review and Meta-Analysis of the Medium- and Long-Term Outcomes of the Boston Type 1 Keratoprosthesis. Cornea 2020; 38:1465-1473. [PMID: 31403526 DOI: 10.1097/ico.0000000000002098] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The Boston type 1 keratoprosthesis (KPro), used in patients with high risk of corneal graft failure, is increasingly being used. However, the medium- to long-term outcomes are currently unclear. We analyzed the medium- (2-5 years) and long-term (>5 years) efficacy and safety of the Boston type 1 KPro in terms of visual outcomes, device retention, and postoperative complications. METHODS We last searched electronic databases (Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid MEDLINE Epub Ahead of Print, EMBASE, and CENTRAL) on March 31, 2018. Visual outcomes and device retention at 2 and 5 years, alongside postoperative complications, were primary outcome measures. RESULTS We identified 407 articles. Thirty studies were included in this systematic review and meta-analysis. The combined proportion of eyes with ≥6/60 vision was 62% at 2 years and 51% at 5 years. The combined retention rate was 88% at 2 years and 74% at 5 years. Retroprosthetic membrane (36.6%) and glaucoma (39.3%) were found to be the most common long-term complications. Very few studies showed visual outcomes or retention rates at 5 years, with results sparse and collectively not meaningful because of small patient numbers and ambiguous reporting of follow-up times. CONCLUSIONS The 2-year results indicate that there is a place for the Boston type 1 KPro in the management of corneal blindness. However, there is scarce evidence regarding its medium- and long-term efficacy and safety. The high rate of reported complications necessitates strict patient selection and stringent follow-up.
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Enders P, Hall J, Bornhauser M, Mansouri K, Altay L, Schrader S, Dietlein TS, Bachmann BO, Neuhann T, Cursiefen C. Telemetric Intraocular Pressure Monitoring after Boston Keratoprosthesis Surgery Using the Eyemate-IO Sensor: Dynamics in the First Year. Am J Ophthalmol 2019; 206:256-263. [PMID: 30849343 DOI: 10.1016/j.ajo.2019.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To analyze the dynamics of telemetrically measured intraocular pressure (IOP) during the first year after implantation of a Boston keratoprosthesis type I (BI-KPro) cornea and to compare agreement of telemetric IOP measurements with finger palpations. DESIGN Prospective, open-label, multicenter, single-arm clinical trial. METHODS In the ARGOS (NCT02945176) study, 12 individuals underwent implantation of an Eyemate-IO intraocular system. Follow-up after surgery took place 12 months later with 13 visits planned per patient. During BI-KPro surgery, an electromagnetic induction sensor ring enabling telemetric IOP data transfer to a hand-held reading device outside the eye was implanted into the ciliary sulcus with or without trans-scleral suture fixation. Comprehensive ophthalmic examinations and IOP assessments through the telemetric system were compared to IOP assessed by finger palpation by 2 experts. RESULTS Preoperative IOP measured by Goldmann tonometry was 13.4 ± 6.2 mm Hg. Telemetric IOP peaked at 23.1 ± 16.5 mm Hg at the first postoperative day. On day 5, mean IOP was 16.0 ± 5.2 mm Hg and 20.95 ± 6.5 mm Hg after 6-12 months. IOP estimation by finger palpation was grouped in 4 categories: normal, A; soft/hypotonic, B; borderline, C; and hypertonic, D. Mean telemetric IOP was 18.2 ± 6.1 mm Hg in category A, 8.9 ± 2.8 mm Hg in B, 22.4 ± 4.9 mm Hg in C, and 34.3 ± 11.0 mm Hg in D. Differences in mean telemetric IOPs per category were statistically significant (P < .001). Daily IOP fluctuations and peaks could be identified. CONCLUSIONS Telemetric IOP assessment seems to be able to identify postoperative IOP peaks and a longitudinal increase of IOP after BI-KPro surgery. IOP measurements using the telemetric Eyemate-IO sensor showed a satisfactory agreement with those of finger palpations by 2 experts.
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Basu S, Serna-Ojeda JC, Senthil S, Pappuru RR, Bagga B, Sangwan V. The Aurolab Keratoprosthesis (KPro) versus the Boston Type I Kpro: 5-year Clinical Outcomes in 134 Cases of Bilateral Corneal Blindness. Am J Ophthalmol 2019; 205:175-183. [PMID: 30905723 DOI: 10.1016/j.ajo.2019.03.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the clinical outcomes of Boston Type I keratoprosthesis (Boston Kpro) with its low-cost version, the Aurolab Kpro (auroKPro). DESIGN Retrospective comparative case series. METHODS This study included 134 eyes of 130 patients with severe bilateral corneal blindness but with wet ocular surfaces. The patients underwent either Boston Kpro (n = 78) or auroKPro (n = 56) implantation based on the device availability and patient's affordability. The primary outcome measurements were anatomical retention (defined as absence of device extrusion, exchange, or explantation) and functional recovery of 20/200 or better visual acuity at yearly time points until 5-years of follow-up. RESULTS Limbal stem cell deficiency was the most common indication (60.5%) for surgery, followed by multiple failed grafts (35%). Both groups were comparable at baseline with respect to indications for surgery and associated ocular co-morbidities (P > 0.05). The overall anatomical retention rates were similar in the Boston Kpro (55 of 78, 70.5%) and auroKPro (35 of 56, 62.5%) groups (P = 0.11). Kaplan-Meier survival rates at 5 years of follow-up were greater for the Boston Kpro with respect to both anatomical retention (63 ± 6% vs. 43.4 ± 10%, respectively; P = 0.057) and functional recovery (42.4 ± 6% vs. 32.2 ± 7%, respectively; P = 0.345), but these differences were not statistically significant. Complications such as intraoperative device breakage (7%) and postoperative extrusions (12.5%) were significantly more common with the auroKPro (P = 0.023). CONCLUSIONS Both the auroKPro and the Boston Kpro are effective treatment options for patients with severe bilateral corneal blindness. The auroKPro can be considered an alternative to the Boston Kpro when affordability or availability of the Boston Kpro is a limiting factor.
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Affiliation(s)
- Sayan Basu
- Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India.
| | | | - Sirisha Senthil
- VST Glaucoma Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajeev Reddy Pappuru
- Kannuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Bhupesh Bagga
- Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender Sangwan
- Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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de la Paz MF, Salvador-Culla B, Charoenrook V, Temprano J, Álvarez de Toledo J, Grabner G, Michael R, Barraquer RI. Osteo-odonto-, Tibial bone and Boston keratoprosthesis in clinically comparable cases of chemical injury and autoimmune disease. Ocul Surf 2019; 17:476-483. [DOI: 10.1016/j.jtos.2019.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/05/2019] [Accepted: 04/09/2019] [Indexed: 01/16/2023]
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Outcomes of the Boston Type I Keratoprosthesis as the Primary Penetrating Corneal Procedure. Cornea 2018; 37:1400-1407. [DOI: 10.1097/ico.0000000000001735] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shanbhag SS, Saeed HN, Paschalis EI, Chodosh J. Boston keratoprosthesis type 1 for limbal stem cell deficiency after severe chemical corneal injury: A systematic review. Ocul Surf 2018; 16:272-281. [PMID: 29597010 DOI: 10.1016/j.jtos.2018.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/23/2018] [Accepted: 03/21/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE To systematically review the published literature on outcomes of Boston keratoprosthesis type 1 for the treatment of limbal stem cell deficiency secondary to severe chemical corneal injury. METHODS Literature searches were conducted in MEDLINE (Ovid), Embase, Web of Science, and the Cochrane Central Register. The main outcome measures assessed were the proportion of eyes with best-corrected visual acuity (BCVA) ≥ 20/200 and the proportion retaining their original keratoprosthesis, both at the last recorded visit. RESULTS We identified 9 reports in which outcomes of Boston keratoprosthesis type I implantation after severe chemical injury could be determined, encompassing a total of 106 eyes of 100 patients. There were no randomized controlled studies. The median pre-operative BCVA was hand motion. Vision improved to ≥20/200 in 99/106 (93.4%) eyes after implantation. With a mean follow-up of 24.99 ± 14 months, 68/106 (64.1%) eyes retained BCVA ≥ 20/200 at the last examination. Therefore, 68/99 (68.7%) of those who improved to > 20/200 maintained at least this acuity. The originally implanted device was retained in 88/99 (88.9%) recipients for whom retention was reported. The mean time to failure was 22.36 ± 17.2 months. Glaucomatous optic neuropathy was the most common cause for BCVA <20/200 in eyes that retained the keratoprosthesis (18/27, 66.7%).. CONCLUSIONS Implantation of a Boston keratoprosthesis type I in eyes with corneal blindness after severe chemical ocular injury leads to functional vision in the majority of recipients. Evidence was limited by variability in outcome reporting and an absence of controlled studies..
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Affiliation(s)
- Swapna S Shanbhag
- Disruptive Technology Laboratory, Mass. Eye & Ear, 243 Charles Street, Boston, MA 02114, USA
| | - Hajirah N Saeed
- Disruptive Technology Laboratory, Mass. Eye & Ear, 243 Charles Street, Boston, MA 02114, USA
| | - Eleftherios I Paschalis
- Disruptive Technology Laboratory, Mass. Eye & Ear, 243 Charles Street, Boston, MA 02114, USA
| | - James Chodosh
- Disruptive Technology Laboratory, Mass. Eye & Ear, 243 Charles Street, Boston, MA 02114, USA.
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Shanbhag SS, Saeed HN, Paschalis EI, Chodosh J. Keratolimbal allograft for limbal stem cell deficiency after severe corneal chemical injury: a systematic review. Br J Ophthalmol 2017; 102:1114-1121. [DOI: 10.1136/bjophthalmol-2017-311249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/17/2017] [Accepted: 10/26/2017] [Indexed: 11/04/2022]
Abstract
PurposeTo review the published literature on outcomes of keratolimbal allograft (KLAL) for the surgical treatment of limbal stem cell deficiency (LSCD) and corneal blindness after severe corneal chemical injury.MethodsLiterature searches were conducted in the following electronic databases: MEDLINE, EMBASE, Science Citation Index, CINAHL, LILACS and the Cochrane Library. Standard systematic review methodology was applied. The main outcome measure was the proportion of eyes with best-corrected visual acuity (BCVA) ≥20/200 at last follow-up. Other measures of allograft success were also collected.ResultsWe identified six reports in which KLAL outcomes in the eyes after chemical injury could be distinguished. There were no randomised controlled studies. The outcomes of KLAL in 36 eyes of 33 patients were analysed. One study with seven eyes did not specify KLAL follow-up specific to chemical injury. Median postoperative follow-up for the other 29 eyes in 26 patients was 42 months (range 6.2–114 months). In the same 29 eyes, 69% (20/29) had BCVA ≥20/200 at the last follow-up examination. Eighty-nine per cent of all eyes (32/36) underwent penetrating keratoplasty simultaneous or subsequent to KLAL.ConclusionsThe number of studies where outcomes of KLAL in eyes with severe corneal chemical injury could be discerned was limited, and variability was observed in outcome reporting. The quality of evidence to support the use of KLAL in LSCD in severe chemical corneal burns was low. Standardisation and longer follow-up are needed to better define evidence-based best practice when contemplating surgical intervention for blindness after corneal chemical injury.PROSPERO registration numberCRD42017054733.
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Evidence-Based Update on Ocular Chemical Injuries. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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