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Li G, Aldave AJ, Amescua G, Colby KA, Cortina MS, de la Cruz J, Parel JMA, Schmiedel TB, Akpek EK. Design and Biocompatibility of a Novel, Flexible Artificial Cornea. Transl Vis Sci Technol 2024; 13:19. [PMID: 38776107 PMCID: PMC11127488 DOI: 10.1167/tvst.13.5.19] [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: 12/20/2023] [Accepted: 04/16/2024] [Indexed: 05/27/2024] Open
Abstract
Purpose We sought to introduce the materials, design, and biocompatibility of a flexible and suturable artificial corneal device. Methods Single-piece, fully synthetic, optic-skirt design devices were made from compact perfluoroalkoxy alkane. The skirt and the optic wall surfaces were lined with a porous tissue ingrowth material using expanded polytetrafluoroethylene. Full-thickness macroapertures around the skirt perimeter were placed to facilitate nutrition of the recipient cornea. Material properties including the skirt's modulus of elasticity and bending stiffness, optic light transmission, wetting behavior, topical drug penetrance, and degradation profile were evaluated. Results The final prototype suitable for human use has a transparent optic with a diameter of 4.60 mm anteriorly, 4.28 mm posteriorly, and a skirt outer diameter of 6.8 mm. The biomechanical and optical properties of the device closely align with the native human cornea with an average normalized device skirt-bending stiffness of 4.7 kPa·mm4 and light transmission in the visible spectrum ranging between 92% and 96%. No optical damage was seen in the 36 devices tested in fouling experiments. No significant difference was observed in topical drug penetrance into the anterior chamber of the device implanted eye compared with the naïve rabbit eye. Conclusions The flexibility and biocompatibility of our artificial cornea device may offer enhanced tissue integration and decreased inflammation, leading to improved retention compared with rigid keratoprosthesis designs. Translational Relevance We have developed a fully synthetic, flexible, suturable, optic-skirt design prototype artificial cornea that is ready to be tested in early human feasibility studies.
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Affiliation(s)
- Gavin Li
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony J. Aldave
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - Kathryn A. Colby
- Department of Ophthalmology at New York University Grossman School of Medicine, New York University, NY, USA
| | - Maria S. Cortina
- Illinois Eye and Ear Infirmary, University of Illinois, Chicago, IL, USA
| | - Jose de la Cruz
- Illinois Eye and Ear Infirmary, University of Illinois, Chicago, IL, USA
| | - Jean-Marie A. Parel
- Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - Thomas B. Schmiedel
- Innovation Center of Excellence, W. L. Gore & Associates, Inc., Newark, DE, USA
| | - Esen Karamursel Akpek
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 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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Akpek EK, Aldave AJ, Amescua G, Colby KA, Cortina MS, de la Cruz J, Parel JMA, Li G. Twelve-Month Clinical and Histopathological Performance of a Novel Synthetic Cornea Device in Rabbit Model. Transl Vis Sci Technol 2023; 12:9. [PMID: 37561510 PMCID: PMC10431210 DOI: 10.1167/tvst.12.8.9] [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: 04/29/2023] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
Purpose To report the biological stability and postoperative outcomes of a second-generation, single-piece, flexible synthetic cornea in a rabbit model. Methods Device materials and design were amended to enhance biointegration. Optic skirt design devices were made from compact perfluoroalkoxy alkane with porous expanded polytetrafluoroethylene ingrowth surface overlying the skirt and optic wall. Sixteen devices were implanted into intrastromal pocket in rabbit eyes. Rabbits were randomly assigned to 6- and 12-month follow-up cohorts (n = 8 in each) postoperatively. Monthly examinations and optical coherence tomography assessed cornea-device integration, iridocorneal angle, optic nerve, and retina. Results There were no intraoperative complications. All devices were in situ at exit, with clear optics. No retroprosthetic membrane, glaucoma, cataract formation, or retinal detachment was observed. Two rabbits in the 6-month group had mild, focal anterior lamella thinning without retraction adjacent to the optic near tight sutures. Three postoperative complications occurred in the 12-month group. One rabbit diagnosed with endophthalmitis was euthanized on day 228. Mild sterile focal retraction of anterior lamella occurred in two rabbits, which were terminated on days 225 and 315. Light microscopic examination of enucleated globes demonstrated fibroplasia with new collagen deposition into the porous scaffold without significant inflammation, encapsulation, or granuloma formation. Conclusions Clinical evaluations, imaging, and histopathological findings indicate favorable outcomes of this synthetic corneal device in a rabbit model. Early feasibility studies in humans are being planned. Translational Relevance Favorable 12-month results of the device in rabbits demonstrate vision-restoring potential in corneally blind individuals at high risk of failure with donor keratoplasty.
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Affiliation(s)
- Esen Karamursel Akpek
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anthony J. Aldave
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Kathryn A. Colby
- Department of Ophthalmology at New York University Grossman School of Medicine, New York University, New York, New York, USA
| | - Maria S. Cortina
- Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA
| | - Jose de la Cruz
- Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA
| | - Jean-Marie A. Parel
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Gavin Li
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Arteaga AC, Weiss MC, Perez R, Cortina MS. Metalloproteinase-9 in the ocular surface of patients with implanted Boston type 1 keratoprosthesis. CORNEA OPEN 2023; 2:e0008. [PMID: 37092032 PMCID: PMC10121193 DOI: 10.1097/coa.0000000000000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE To characterize the presence of ocular surface inflammation, using matrix metalloproteinase 9 (MMP-9) as a marker, in the ocular surface of eyes with implanted Boston Keratoprosthesis type 1 (KPro). METHODS Patients with implanted KPro at a single tertiary center were recruited to assess ocular inflammation. MMP-9 was measured using InflammaDry® test in both eyes of each patient. The non-KPro eye served as control. Rate of positivity of MMP-9 was compared between groups. Possible associations between ocular surface inflammation and the development of postoperative complications were evaluated using univariate statistical analysis. RESULTS Fifty eyes from 25 patients were included. The mean age was 50 years old. Non-inflammatory indications for KPro were predominant among patients. Eighty eight percent of KPro eyes had a positive test for MMP-9 while only 25% of control eyes were positive (p<001). The most common complications were retroprosthetic membrane, epithelial defects, and sterile corneal melt. The presence of a strong positive result was associated to a higher frequency of complications (80% of eyes) compared to a faint positive test (54%) and a negative test (33%). CONCLUSION The KPro device appears to increase MMP-9 levels in the ocular surface. High MMP-9 levels may be associated with higher risk of complications. MMP-9 testing can be useful to assess subclinical ocular surface inflammation with a potential role in the postoperative care of KPro patients.
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Affiliation(s)
- Andrea C Arteaga
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL
| | - Margaret C. Weiss
- School of Public Health, University of Illinois at Chicago, Chicago, IL
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Raiza Perez
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL
| | - María Soledad Cortina
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL
- Corresponding author: M. Soledad Cortina, MD, Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor Street, M/C 648, Chicago, IL 60612,
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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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Baradaran-Rafii A, Eslani M, Haq Z, Shirzadeh E, Huvard MJ, Djalilian AR. Current and Upcoming Therapies for Ocular Surface Chemical Injuries. Ocul Surf 2016; 15:48-64. [PMID: 27650263 DOI: 10.1016/j.jtos.2016.09.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 01/11/2023]
Abstract
Chemical injuries frequently result in vision loss, disfigurement, and challenging ocular surface complications. Acute interventions are directed at decreasing the extent of the injury, suppressing inflammation, and promoting ocular surface re-epithelialization. Chronically, management involves controlling inflammation along with rehabilitation and reconstruction of the ocular surface. Future therapies aimed at inhibiting neovascularization and promoting ocular surface regeneration should provide more effective treatment options for the management of ocular chemical injuries.
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Affiliation(s)
| | - Medi Eslani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Zeeshan Haq
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ebrahim Shirzadeh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael J Huvard
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.
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Periprosthetic Tissue Loss in Patients With Idiopathic Vitreous Inflammation After the Boston Keratoprosthesis. Cornea 2016; 34:1378-82. [PMID: 26226472 DOI: 10.1097/ico.0000000000000557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Idiopathic vitritis is a poorly understood complication after Boston keratoprosthesis surgery with unclear etiology. We sought to determine whether an association exists between periprosthetic corneal tissue loss and the development of idiopathic vitritis in keratoprosthesis recipients. METHODS Thirteen Boston type I keratoprosthesis recipient eyes with a history of idiopathic vitritis and 34 type I keratoprosthesis recipient eyes with no history of idiopathic vitritis underwent anterior segment optical coherence tomography (AS-OCT) at a median time postoperatively of 2.4 years versus 1.9 years (range, 0.5-14.2 vs. 0.1-13.6 years), respectively. Areas of corneal graft tissue loss ("gaps") around the keratoprosthesis stem were identified and analyzed by 2 masked observers. The difference in the presence, number, and size of gaps was compared between cases and controls. RESULTS A periprosthetic gap was identified more commonly in idiopathic vitritis cases than in controls on AS-OCT (11/13, 86% vs. 11/34, 33.3%, P < 0.001). The number of gaps between cases and controls was also significantly different (2.6 ± 1.6 vs. 0.5 ± 0.8, P < 0.001), but not the estimated gap area (0.056 ± 0.049 mm² vs. 0.039 ± 0.025 mm², P = 0.22). CONCLUSIONS A significantly higher proportion of keratoprosthesis recipient eyes with idiopathic vitritis had corneal tissue loss around the keratoprosthesis stem than did controls. Tissue loss could serve as an entry point for debris or bacterial components, triggering idiopathic vitritis. Our study underscores the utility of AS-OCT imaging in the postoperative management of keratoprosthesis patients.
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van Essen TH, van Zijl L, Possemiers T, Mulder AA, Zwart SJ, Chou CH, Lin CC, Lai HJ, Luyten GPM, Tassignon MJ, Zakaria N, El Ghalbzouri A, Jager MJ. Biocompatibility of a fish scale-derived artificial cornea: Cytotoxicity, cellular adhesion and phenotype, and in vivo immunogenicity. Biomaterials 2015; 81:36-45. [PMID: 26717247 DOI: 10.1016/j.biomaterials.2015.11.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine whether a fish scale-derived collagen matrix (FSCM) meets the basic criteria to serve as an artificial cornea, as determined with in vitro and in vivo tests. METHODS Primary corneal epithelial and stromal cells were obtained from human donor corneas and used to examine the (in)direct cytotoxicity effects of the scaffold. Cytotoxicity was assessed by an MTT assay, while cellular proliferation, corneal cell phenotype and adhesion markers were assessed using an EdU-assay and immunofluorescence. For in vivo-testing, FSCMs were implanted subcutaneously in rats. Ologen(®) Collagen Matrices were used as controls. A second implant was implanted as an immunological challenge. The FSCM was implanted in a corneal pocket of seven New Zealand White rabbits, and compared to sham surgery. RESULTS The FSCM was used as a scaffold to grow corneal epithelial and stromal cells, and displayed no cytotoxicity to these cells. Corneal epithelial cells displayed their normal phenotypical markers (CK3/12 and E-cadherin), as well as cell-matrix adhesion molecules: integrin-α6 and β4, laminin 332, and hemi-desmosomes. Corneal stromal cells similarly expressed adhesion molecules (integrin-α6 and β1). A subcutaneous implant of the FSCM in rats did not induce inflammation or sensitization; the response was comparable to the response against the Ologen(®) Collagen Matrix. Implantation of the FSCM in a corneal stromal pocket in rabbits led to a transparent cornea, healthy epithelium, and, on histology, hardly any infiltrating immune cells. CONCLUSION The FSCM allows excellent cell growth, is not immunogenic and is well-tolerated in the cornea, and thus meets the basic criteria to serve as a scaffold to reconstitute the cornea.
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Affiliation(s)
- T H van Essen
- Department of Ophthalmology, J3-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
| | - L van Zijl
- Department of Research, Aeon Astron Europe B.V., J.H. Oortweg 19, 2333 CH, Leiden, The Netherlands.
| | - T Possemiers
- Department of Ophthalmology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - A A Mulder
- Department of Molecular Cell-biology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
| | - S J Zwart
- Department of Research, Aeon Astron Europe B.V., J.H. Oortweg 19, 2333 CH, Leiden, The Netherlands.
| | - C-H Chou
- Department of Research, Body Organ Biomedical Corporation, 5F, No. 153, Section 3, Xinyi Road, Da'an District, Taipei City 106, Taiwan, ROC.
| | - C C Lin
- Department of Research, Body Organ Biomedical Corporation, 5F, No. 153, Section 3, Xinyi Road, Da'an District, Taipei City 106, Taiwan, ROC.
| | - H J Lai
- Department of Research, Aeon Astron Europe B.V., J.H. Oortweg 19, 2333 CH, Leiden, The Netherlands.
| | - G P M Luyten
- Department of Ophthalmology, J3-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
| | - M J Tassignon
- Department of Ophthalmology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - N Zakaria
- Department of Ophthalmology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium.
| | - A El Ghalbzouri
- Department of Molecular Cell-biology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
| | - M J Jager
- Department of Ophthalmology, J3-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Sharma N, Falera R, Arora T, Agarwal T, Bandivadekar P, Vajpayee RB. Evaluation of a low-cost design keratoprosthesis in end-stage corneal disease: a preliminary study. Br J Ophthalmol 2015; 100:323-7. [DOI: 10.1136/bjophthalmol-2015-306982] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/08/2015] [Indexed: 12/27/2022]
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Al Arfaj K. Boston keratoprosthesis - Clinical outcomes with wider geographic use and expanding indications - A systematic review. Saudi J Ophthalmol 2015; 29:212-21. [PMID: 26155082 PMCID: PMC4487949 DOI: 10.1016/j.sjopt.2015.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/24/2014] [Accepted: 02/02/2015] [Indexed: 11/13/2022] Open
Abstract
Over 2 decades of research, several design modifications, and improvements in post-operative management have made Boston keratoprosthesis (B-KPro) a viable option for patients with corneal blindness for whom traditional keratoplasty procedure has a very low probability of success. In this systematic review, we examined the indications, visual outcomes, complications and retention rate of the literature published in the past 10 years (2005–2014). While most of the studies report smaller datasets (typically <50 eyes), some of the recent multicenter studies have reported large datasets (up to 300 eyes). Most of the literature is published from the US; however, last few years have witnessed some papers reporting the successful use of B-Kpro from developing countries or arid climatic conditions (such as the Kingdom of Saudi Arabia). Due to differences in the causes of corneal blindness in different geographic regions, newer indications for B-Kpro are emerging (e.g. trachoma). Additionally, improving clinical outcomes and increasing surgeon confidence have also expanded indications to include cases of unilateral visual impairment and paediatric age. We observed that there is growing body of evidence of successful clinical use of B-KPro; however, financial challenges, lack of trained surgeons, shortage of donor corneas must be overcome to improve accessibility of B-KPro.
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Affiliation(s)
- Khalid Al Arfaj
- Department of ophthalmology, Dammam University, Postal code 40033, King Fahad University Hospital, Alkhobar, Saudi Arabia
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Al Arfaj K. Four-year outcomes and complications of Boston keratoprosthesis type I implantation in the Middle East. SPEKTRUM DER AUGENHEILKUNDE 2014. [DOI: 10.1007/s00717-014-0233-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Eslani M, Baradaran-Rafii A, Movahedan A, Djalilian AR. The ocular surface chemical burns. J Ophthalmol 2014; 2014:196827. [PMID: 25105018 PMCID: PMC4106115 DOI: 10.1155/2014/196827] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/15/2014] [Indexed: 01/21/2023] Open
Abstract
Ocular chemical burns are common and serious ocular emergencies that require immediate and intensive evaluation and care. The victims of such incidents are usually young, and therefore loss of vision and disfigurement could dramatically affect their lives. The clinical course can be divided into immediate, acute, early, and late reparative phases. The degree of limbal, corneal, and conjunctival involvement at the time of injury is critically associated with prognosis. The treatment starts with simple but vision saving steps and is continued with complicated surgical procedures later in the course of the disease. The goal of treatment is to restore the normal ocular surface anatomy and function. Limbal stem cell transplantation, amniotic membrane transplantation, and ultimately keratoprosthesis may be indicated depending on the patients' needs.
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Affiliation(s)
- Medi Eslani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | | - Asadolah Movahedan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ali R. Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
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