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Gómez SG, Ginebra MP, Gil FJ, Barraquer RI, Manero JM. Antibacterial and cytocompatible silver coating for titanium Boston Keratoprosthesis. Front Bioeng Biotechnol 2024; 12:1421706. [PMID: 39364264 PMCID: PMC11446748 DOI: 10.3389/fbioe.2024.1421706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 09/02/2024] [Indexed: 10/05/2024] Open
Abstract
The Boston Keratoprosthesis (BKPro) serves as a medical solution for restoring vision in complex cases of corneal blindness. Comprising a front plate made of polymethylmethacrylate (PMMA) and a back plate of titanium (Ti), this device utilizes the beneficial biomaterial properties of Ti. While BKPro demonstrates promising retention rates, infection emerges as a significant concern that impacts its long-term efficacy. However, limited research exists on enhancement of BKPros through intrinsic infection-preventing mechanisms. In this regard, metal ions, especially the well-known Ag+ ions, are a promising alternative to obtain implants with innate antibacterial properties. However, little information is available about the effects of Ag in corneal tissue, especially within human corneal keratocytes (HCKs). In this work, an electrodeposition treatment using a constant pulse is proposed to attach Ag complexes onto rough Ti surfaces, thus providing antibacterial properties without inducing cytotoxicity. Complete physicochemical characterization and ion release studies were carried out with both control and Ag-treated samples. The possible cytotoxic effects in the short and long term were evaluated in vitro with HCKs. Moreover, the antibacterial properties of the silver-treated surfaces were tested against the gram-negative bacterial strain Pseudomonas aeruginosa and the gram-positive strain Staphylococcus epidermidis, that are common contributors to infections in BKPros. Physicochemical characterization confirmed the presence of silver, predominantly in oxide form, with low release of Ag+ ions. Ag-treated surfaces demonstrated no cytotoxicity and promoted long-term proliferation of HCKs. Furthermore, the silver-treated surfaces exhibited a potent antibacterial effect, causing a reduction in bacterial adhesion and evident damage to the bacterial cell walls of P. aeruginosa and S. epidermidis. The low release of Ag+ ions suggested reactive oxygen species (ROS)-mediated oxidative stress imbalance as the bactericidal mechanism of the silver deposits. In conclusion, the proposed electrodeposition technique confers antibacterial protection to the Ti backplate of BKPro, mitigating implant-threatening infections while ensuring non-cytotoxicity within the corneal tissue.
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Affiliation(s)
- Silvia González Gómez
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya. Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), Barcelona, Spain
- Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, Barcelona, Spain
| | - Maria-Pau Ginebra
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya. Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), Barcelona, Spain
- Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Javier Gil
- Bioengineering Institute of Technology. Universitat Internacional de Catalunya. Barcelona, Barcelona, Spain
| | - Rafael I Barraquer
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - José María Manero
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya. Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), Barcelona, Spain
- Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, Barcelona, Spain
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Chen Y, Li S, He H. miR-27a-3p promotes inflammatory response in infectious endophthalmitis via targeting TSC1. Sci Rep 2024; 14:19353. [PMID: 39169069 PMCID: PMC11339321 DOI: 10.1038/s41598-024-69964-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024] Open
Abstract
Infectious endophthalmitis (IE) poses a significant threat to vision. This study aimed to explore the impact of microRNA (miR)-27a-3p on inflammation in IE. A rat model was developed through intravitreal injection of lipopolysaccharide. Clinical and demographic data were collected for 54 participants: 31 diagnosed with IE and 23 non-infectious patients with idiopathic macular holes. Expression levels of miR-27a-3p and inflammatory genes were quantified via reverse transcription quantitative polymerase chain reaction. Concentrations of inflammatory cytokines in human vitreous samples were measured using enzyme-linked immunosorbent assay. In vitro studies were conducted to explore the target gene of miR-27a-3p. The final animal experiments further verified the role of miR-27a-3p and tuberous sclerosis complex (TSC)1 in inflammatory responses. Results showed that miR-27a-3p was elevated in LPS-treated rats and IE patients. Thirty-one IE patients were divided into the High (n = 15) and Low (n = 16) groups according to the expression of miR-27a-3p. No significant differences were observed in baseline clinical and demographic characteristics between the control and IE patient groups. Pro-inflammatory cytokine mRNA levels and concentrations were notably increased in both LPS-treated rats and the High group of patients. Besides, results showed that TSC1 is a target gene of miR-27a-3p. Moreover, TSC1 inhibition promoted inflammation in rat vitreous samples. In summary, our findings suggested that miR-27a-3p exacerbated inflammatory responses in IE though targeting TSC1, offering novel insights for potential therapeutic strategies targeting miR-27a-3p in the clinical management of IE.
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Affiliation(s)
- Yanting Chen
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.19 Xiuhua Road, Xiuying District, Haikou, 570311, Hainan, China.
| | - Shanxiang Li
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.19 Xiuhua Road, Xiuying District, Haikou, 570311, Hainan, China
| | - Hong He
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.19 Xiuhua Road, Xiuying District, Haikou, 570311, Hainan, China
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De Wit-Carter G, Hernández-Chavarría C, Navarro-Naranjo PI, Manzanillo-Rosario C, Navarro-Saucedo R, García-Albisua AM, Hernandez-Quintela E, Cabrera-Martínez E, Ordoñez-Ranz G, Sanchez-Huerta V. Boston Keratoprosthesis type 1 (KPro) without contact lens wearing in end-stage corneal disease: The APEC experience. Eur J Ophthalmol 2024; 34:1063-1070. [PMID: 38099653 DOI: 10.1177/11206721231214076] [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] [Indexed: 08/02/2024]
Abstract
PURPOSE To report the visual outcomes and survival analysis of keratoprosthesis without contact lens wearing in a tertiary eye care hospital in Mexico City, Asociación Para Evitar La Ceguera (APEC, Coyoacán, México). DESIGN Retrospective cohort with survival analysis. PARTICIPANTS Twenty-three eyes (22 patients) received KPro type 1 between 2015 and 2020 with a follow-up time of three years. METHODS We included analyzed data about past medical history, preoperative diagnosis, best-spectacle visual acuity (BSCVA), postoperative complications and retention rate. Univariate, bivariate and survival analysis were performed and reported. RESULTS The mean age was 58 ± 13.5 years (SD). 60.86% were male patients (14 eyes). Twelve-eyes (52%) achieved a BSCVA of 20/200 or better in the first and second year of follow-up. At 3 years, only 35% achieved 20/200 or better (BSCVA). Retention rate of Boston type 1 KPro was 87% (20 eyes) at 3 years follow-up. The most common complication was retroprosthetic membrane (RPM) which occurred in 9 eyes (39.1%), followed by corneal melting in 7 eyes (30.4%). CONCLUSIONS We report the results of a retrospective cohort of twenty-three eyes (22 patients) who were implanted with a Boston type 1 KPro without contact lens wearing to treat corneal blindness. BSCVA improved significantly in most patients achieving 20/200 or better at the 2-year follow-up. Retention rate was 87%, with the presence of RPM as the most common complication.
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Affiliation(s)
- Guillermo De Wit-Carter
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - César Hernández-Chavarría
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - Pedro-Ivan Navarro-Naranjo
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
- Cornea and External Diseases, Private Solo-Practice, Asociación Médica de Los Andes, Bogotá, Colombia
| | - Cristal Manzanillo-Rosario
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - Ricardo Navarro-Saucedo
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | | | - Everardo Hernandez-Quintela
- Division of Comprehensive Eye Care, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emmanuel Cabrera-Martínez
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - Gabriela Ordoñez-Ranz
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - Valeria Sanchez-Huerta
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
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Gómez SG, Guillem-Marti J, Martín-Gómez H, Mas-Moruno C, Ginebra MP, Gil FJ, Barraquer RI, Manero JM. Titanium Boston keratoprosthesis with corneal cell adhesive and bactericidal dual coating. BIOMATERIALS ADVANCES 2023; 154:213654. [PMID: 37837906 DOI: 10.1016/j.bioadv.2023.213654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
The Boston keratoprosthesis (BKPro) is a medical device used to restore vision in complicated cases of corneal blindness. This device is composed by a front plate of polymethylmethacrylate (PMMA) and a backplate usually made of titanium (Ti). Ti is an excellent biomaterial with numerous applications, although there are not many studies that address its interaction with ocular cells. In this regard, despite the good retention rates of the BKPro, two main complications compromise patients' vision and the viability of the prosthesis: imperfect adhesion of the corneal tissue to the upside of the backplate and infections. Thus, in this work, two topographies (smooth and rough) were generated on Ti samples and tested with or without functionalization with a dual peptide platform. This molecule consists of a branched structure that links two peptide moieties to address the main complications associated with BKPro: the well-known RGD peptide in its cyclic version (cRGD) as cell pro-adherent motif and the first 11 residues of lactoferrin (LF1-11) as antibacterial motif. Samples were physicochemically characterized, and their biological response was evaluated in vitro with human corneal keratocytes (HCKs) and against the gram-negative bacterial strain Pseudomonas aeruginosa. The physicochemical characterization allowed to verify the functionalization in a qualitative and quantitative manner. A higher amount of peptide was anchored to the rough surfaces. The studies performed using HCKs showed increased long-term proliferation on the functionalized samples. Gene expression was affected by topography and peptide functionalization. Roughness promoted α-smooth muscle actin (α-SMA) overexpression, and the coating notably increased the expression of extracellular matrix components (ECM). Such changes may favour the development of unwanted fibrosis, and thus, corneal haze. In contrast, the combination of the coating with a rough topography decreased the expression of α-SMA and ECM components, which would be desirable for the long-term success of the prosthesis. Regarding the antibacterial activity, the functionalized smooth and rough surfaces promoted the death of bacteria, as well as a perturbation in their wall definition and cellular morphology. Bacterial killing values were 58 % for smooth functionalised and 68 % for rough functionalised samples. In summary, this study suggests that the use of the dual peptide platform with cRGD and LF1-11 could be a good strategy to improve the in vitro and in vivo performance of the rough topography used in the commercial BKPro.
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Affiliation(s)
- Silvia González Gómez
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya, Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), 08019 Barcelona, Spain; Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, 08019 Barcelona, Spain; Institut de Recerca Sant Joan de Déu, 08034 Barcelona, Spain
| | - Jordi Guillem-Marti
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya, Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), 08019 Barcelona, Spain; Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, 08019 Barcelona, Spain; Institut de Recerca Sant Joan de Déu, 08034 Barcelona, Spain.
| | - Helena Martín-Gómez
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya, Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), 08019 Barcelona, Spain; Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, 08019 Barcelona, Spain
| | - Carlos Mas-Moruno
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya, Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), 08019 Barcelona, Spain; Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, 08019 Barcelona, Spain; Institut de Recerca Sant Joan de Déu, 08034 Barcelona, Spain
| | - Maria-Pau Ginebra
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya, Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), 08019 Barcelona, Spain; Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, 08019 Barcelona, Spain; Institut de Recerca Sant Joan de Déu, 08034 Barcelona, Spain; Institute for Bioengineering of Catalonia (IBEC), 08028 Barcelona, Spain
| | - Francisco Javier Gil
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
| | | | - José María Manero
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Universitat Politècnica de Catalunya, Barcelona Tech (UPC), Barcelona East School of Engineering (EEBE), 08019 Barcelona, Spain; Barcelona Research Center in Multiscale Science and Engineering, UPC, EEBE, 08019 Barcelona, Spain; Institut de Recerca Sant Joan de Déu, 08034 Barcelona, Spain
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Ra’oh NA, Man RC, Fauzi MB, Ghafar NA, Buyong MR, Hwei NM, Halim WHWA. Recent Approaches to the Modification of Collagen Biomatrix as a Corneal Biomatrix and Its Cellular Interaction. Polymers (Basel) 2023; 15:polym15071766. [PMID: 37050380 PMCID: PMC10097332 DOI: 10.3390/polym15071766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Over the last several decades, numerous modifications and advancements have been made to design the optimal corneal biomatrix for corneal epithelial cell (CECs) or limbal epithelial stem cell (LESC) carriers. However, researchers have yet to discover the ideal optimization strategies for corneal biomatrix design and its effects on cultured CECs or LESCs. This review discusses and summarizes recent optimization strategies for developing an ideal collagen biomatrix and its interactions with CECs and LESCs. Using PRISMA guidelines, articles published from June 2012 to June 2022 were systematically searched using Web of Science (WoS), Scopus, PubMed, Wiley, and EBSCOhost databases. The literature search identified 444 potential relevant published articles, with 29 relevant articles selected based on inclusion and exclusion criteria following screening and appraising processes. Physicochemical and biocompatibility (in vitro and in vivo) characterization methods are highlighted, which are inconsistent throughout various studies. Despite the variability in the methodology approach, it is postulated that the modification of the collagen biomatrix improves its mechanical and biocompatibility properties toward CECs and LESCs. All findings are discussed in this review, which provides a general view of recent trends in this field.
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Affiliation(s)
- Nur Amalia Ra’oh
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Rohaina Che Man
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norzana Abd Ghafar
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Muhamad Ramdzan Buyong
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ng Min Hwei
- Centre for Tissue Engineering and Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Wan Haslina Wan Abdul Halim
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Abstract
Millions of people worldwide are bilaterally blind due to corneal diseases including infectious etiologies, trauma, and chemical injuries. While corneal transplantation can successfully restore sight in many, corneal graft survival decreases in eyes with chronic inflammation and corneal vascularization. Additionally, the availability of donor cornea material can be limited, especially in underdeveloped countries where corneal blindness may also be highly prevalent. Development of methods to create and implant an artificial cornea (keratoprosthesis)may be the only option for patients whose eye disease is not suitable for corneal transplantation or who live in regions where corneal transplantation is not possible. The Boston keratoprosthesis (B-KPro) is the most commonly implanted keratoprosthesis worldwide, having restored vision in thousands of patients. This article describes the initial design of the B-KPro and the modifications that have been made over many years. Additionally, some of the complications of surgical implantation and long-term care challenges, particularly complicating inflammation and glaucoma, are discussed. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Claes Dohlman
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA;
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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: 7] [Impact Index Per Article: 3.5] [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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8
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Chen P, Mar Z, Giannetti A, Hughes S, Gilbert J, Zhao F. An Exploratory Study of a New Vancomycin Eye Drops Formulation for Extemporaneous Compounding. Hosp Pharm 2022; 57:69-75. [PMID: 35521008 PMCID: PMC9065524 DOI: 10.1177/0018578720973885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose Compounded eye drop solutions of vancomycin hydrochloride have important clinical applications, such as postoperative antimicrobial prophylaxis and bacterial keratitis. There exists a plethora of data to support the use of various liquid vehicles to compound vancomycin hydrochloride eye drops. However, there are a number of limitations for implementation, especially the frequent shortage or discontinuation of the vehicle products. This study was designed to investigate the use of an OTC eye wash product as the evergreen vehicle and to evaluate the physical and chemical stability of the new formulation. Methods The Advance Eye Relief® eye wash and vancomycin hydrochloride for injection vials were used to prepare 10 and 50 mg/mL vancomycin eye drop solutions. The solutions were packaged in Steri-Droppers® bottles and stored in a freezer for 14 days followed by 28 days in refrigeration. The 14-day period of freezing was included to allow time for sterility testing. At pre-determined stability time points, samples were taken for visual inspection, pH and osmolality measurement, and analysis by a stability-indicating high performance liquid chromatography (HPLC) method. Results Freshly prepared vancomycin eye drops were clear, colorless, and free of particulates. The pH readings were 7.03 and 6.28 for the 10 and 50 mg/mL solutions, respectively. The osmolality of both solutions were within the range of 300-330 mOsmol/kg and considered isotonic. Initial drug concentrations of all samples were confirmed by HPLC to be within 100%-103% of the label claims. Throughout the stability study period, there were no significant changes in the appearance, pH, or osmolality of any samples. The HPLC results also confirmed that the drug concentrations in all stability samples were within 98%-101% of the initial time zero values and no significant degradation product peaks were observed. Conclusion A new compounded vancomycin eye drop formulation was developed to mitigate vehicle sourcing issues. This eye drop formulation was easy to prepare, exhibited satisfactory properties for ophthalmic applications, and remained stable chemically and physically when stored for 14 days in freezer followed by 28 days in refrigerator.
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Affiliation(s)
- Pang Chen
- St. John Fisher College, Rochester, NY, USA,Pang Chen, St. John Fisher College, 3690 East Avenue, Rochester, NY 14610, USA.
| | - Zin Mar
- St. John Fisher College, Rochester, NY, USA
| | | | - Susan Hughes
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Fang Zhao
- St. John Fisher College, Rochester, NY, USA
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Lee T, Robbins CB, Wisely CE, Grewal DS, Daluvoy MB, Fekrat S. CLINICAL CHARACTERISTICS AND VISUAL OUTCOMES IN ENDOPHTHALMITIS AFTER KERATOPROSTHESIS IMPLANTATION. Retina 2022; 42:321-327. [PMID: 34483314 DOI: 10.1097/iae.0000000000003300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the presentation, microbiology, management, and prognosis of eyes with endophthalmitis after Boston keratoprosthesis implantation. METHODS Retrospective case series with history, diagnostics, management, and outcomes data in endophthalmitis after keratoprosthesis implantation presenting to a tertiary center between 2009 and 2020. RESULTS Of 137 keratoprosthesis-implanted eyes, 7 eyes of 7 patients (5%) developed endophthalmitis. On presentation, 6 (86%) reported decreased visual acuity, and only 1 (14%) reported pain. Peripheral corneal ulcers were present in 2 eyes (29%). Seidel testing was negative in all cases. Six eyes (86%) had retroprosthetic membranes. One (14%) underwent initial pars plana vitrectomy with mechanical vitreous biopsy, whereas 6 (86%) received a needle vitreous tap-half of which were dry. Organisms were isolated after vitreous tap in two eyes: Streptococcus intermedius and Mycobacterium abscessus. The mean visual acuity preendophthalmitis, at presentation, and at 6 months were 20/267, 20/5,944, and 20/734, respectively. The visual acuity improved 9.08 ± 11.78 Early Treatment Diabetic Retinopathy Study lines from presentation to 6 months. Six-month visual acuity was correlated with preendophthalmitis visual acuity (r = 0.92, P = 0.003) but not presenting visual acuity (P = 0.838). CONCLUSION Visual acuity at 6 months is correlated with preendophthalmitis visual acuity, not presenting visual acuity. Endophthalmitis should be considered in the differential diagnosis of painless intraocular inflammation any time after keratoprosthesis implantation, even if Seidel negative.
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Affiliation(s)
- Terry Lee
- Duke University School of Medicine, Durham, North Carolina; and
| | - Cason B Robbins
- Duke University School of Medicine, Durham, North Carolina; and
| | - Clayton E Wisely
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Melissa B Daluvoy
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
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10
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Review: Keratoprothesis in the Pediatric Population. Int Ophthalmol Clin 2022; 62:45-57. [PMID: 34965225 DOI: 10.1097/iio.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Bonnet C, Chehaibou I, Chen A, Bourges JL, Markovic D, Hubschman JP, Aldave AJ. POSTOPERATIVE POSTERIOR SEGMENT COMPLICATIONS AFTER BOSTON TYPE 1 KERATOPROSTHESIS: Incidence, Risk Factors, and Intermediate-Term Outcomes. Retina 2021; 41:2499-2509. [PMID: 34111883 DOI: 10.1097/iae.0000000000003233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify the incidence of, risk factors for, and outcomes of posterior segment complications (PSC) after Boston Type 1 keratoprosthesis (KPro) implantation. METHODS Retrospective, consecutive case series of KPro procedures at the Stein Eye Institute. Data regarding ocular history, intraoperative details, postoperative management, and outcomes were collected. Eyes with at least one PSC (PSC group) were compared with eyes without PSC (No PSC group), and risk factors for PSC were determined. RESULTS Ninety-five PSC occurred in 69/169 eyes (40.8%), at a mean of 20.1 months after KPro implantation (0.01 complications/eye month). The median follow-up after KPro implantation was 44.0 months (range 3.0-174.4). The most common PSC were epiretinal membrane (16.6%), cystoid macular edema (12.4%), vitritis (11.2%), and retinal detachment (9.5%). Previous retinal detachment repair, concomitant intraocular lens removal, postoperative aphakia, and vitritis were risk factors for retinal detachment. Postoperative infectious keratitis was a risk factor for epiretinal membrane, cystoid macular edema, and vitritis. The posterior segment complication group had a significantly higher rate of eyes failing to maintain visual acuity ≥20/200 (HR = 2.28; 95% CI = 1.35-3.85) and KPro retention failure rate (HR = 1.66; 95% CI = 0.95-2.91). CONCLUSION Posterior segment complications occur in approximately 40% of eyes after KPro implantation, resulting in reduced visual outcomes and KPro retention.
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Affiliation(s)
- Clémence Bonnet
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
- Ophthalmology Department, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Ismael Chehaibou
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
- Ophthalmology Department, Université de Paris, AP-HP, Hôpital Lariboisière, Paris; and
| | - Angela Chen
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jean-Louis Bourges
- Ophthalmology Department, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Daniela Markovic
- Department of Medicine Statistics Core, University of California, Los Angeles, California
| | - Jean-Pierre Hubschman
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Anthony J Aldave
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
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Khair D, Salimi A, Harissi-Dagher M. Vitreoretinal Complications in Boston Keratoprosthesis Type 1. Am J Ophthalmol 2021; 231:101-108. [PMID: 34107311 DOI: 10.1016/j.ajo.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the incidence of vitreoretinal complications, treatment modalities, and the visual outcomes in a large cohort of eyes that underwent Boston Keratoprosthesis (KPro) implantation. DESIGN Retrospective, interventional case series. METHODS 132 eyes of 114 patients who underwent KPro implantation at the Centre Hospitalier de l'Université de Montréal from 2008 to 2017 were included with at least 1 year follow-up. Charts were reviewed and data was collected, including demographics, initial corneal indication for surgery, posterior segment complications, preoperative and postoperative visual acuity. RESULTS Mean follow-up was 68.2 months and 61.4% of eyes developed postoperative vitreoretinal complications (VRC). The most common VRC was RPM formation (38.6%, n=51) followed by RD (15.2%, n=20), CME (12.1%, n=16), ERM (9.8%, n=13), endophthalmitis (9.1%, n=12), sterile vitritis (7.6%, n=10), vitreous hemorrhage (6.8%, n=9), choroidal detachment (3.0%, n=4) and central retinal vein occlusion (0.7%, n=1). BCVA improved in the no VRC group from 1.74 ± 0.33 logMAR to 1.33±0.83 logMAR and in the VRC group from 1.74±0.36 logMAR to 1.52±0.83 logMAR, without any statistically significant intergroup differences (p=0.231). RD was the only significant complication associated with poorer visual outcomes (p=0.001). CONCLUSION Potentially blinding secondary complications occur in the majority of patients and frequent monitoring is necessary, specifically in the early and intermediate postoperative periods. This study evidenced significant improvements in visual outcomes of KPro eyes, including those that developed postoperative vitreoretinal complications.
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Bostan C, Nayman T, Szigiato AA, Morfeq H, Harissi-Dagher M. Endophthalmitis in Eyes With the Boston Type I Keratoprosthesis: Incidence, Recurrence, Risk Factors, and Outcomes. Cornea 2021; 40:1258-1266. [PMID: 33394754 DOI: 10.1097/ico.0000000000002641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the incidence and recurrence of Boston type I keratoprosthesis (KPro)-associated endophthalmitis, and its microbiological profile, risk factors, and outcomes. METHODS This is a retrospective study of 158 consecutive KPro procedures with a median follow-up of 78.4 months. Medical charts were reviewed for ocular history, contact lens and topical antibiotic use, visual acuity, and complications. For eyes with endophthalmitis, time to infection, culture results, and recurrences were collected. Cox regression analyses identified risk factors for endophthalmitis and compared the risk for visual failure, KPro retention, and globe loss between eyes with and without endophthalmitis. RESULTS The incidence and recurrence rates of endophthalmitis were of 1.7% and 6.0% per procedure-year, respectively. First episodes occurred at a median of 18.6 months. Eight of 18 episodes (44%) were culture positive, isolating mainly Gram-positive bacteria (7 [88%]). Previous ocular burn (hazard ratio: 7.34, 95% confidence interval: 1.91-28.15), infectious keratitis (5.09, 1.70-15.22), corneal melt (4.55, 1.50-13.83), and postoperative contact lens wear (4.19, 1.17-15.04) were risk factors. Eyes with endophthalmitis did not have a higher risk for visual failure (1.74, 0.78-3.91) but were more likely to not retain the KPro (2.81, 1.15-6.88) and undergo evisceration (2.81, 1.15-6.88). All eyes lost ≥ 2 lines of vision during the endophthalmitis episode. CONCLUSIONS Endophthalmitis is rare but vision and globe threatening in eyes with KPro. Given the increased associated risk, corneal melts and infectious keratitis must be promptly treated, postoperative contact lenses should be considered on a case-by-case basis, and patients with ocular burns might require more aggressive antimicrobial prophylaxis.
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Affiliation(s)
- Cristina Bostan
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
| | - Taylor Nayman
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
| | | | - Hussein Morfeq
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
- Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
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Abstract
PURPOSE To evaluate the antifungal properties of topical antibiotics (already being used successfully to prevent bacterial endophthalmitis) and some promising antiseptics for antifungal prophylaxis in the setting of artificial corneal implantation. METHODS Several commonly used antibiotics for antimicrobial prophylaxis after artificial corneal implantation, in addition to antiseptics [benzalkonium chloride (BAK), povidone-iodine (PI), and some ionic liquids (ILs)], were tested in vitro against Candida albicans, Fusarium solani, and Aspergillus fumigatus. The time-kill activity was determined. Toxicity was assayed in vitro on human corneal epithelial cultures using trypan blue. Adhesion and tissue invasion experiments were also carried out on porcine corneas and commonly used contact lenses, with or without gamma irradiation, and by analysis with fluorescence microscopy. RESULTS Polymyxin B (PMB)/trimethoprim/BAK (Polytrim), PMB alone, gatifloxacin with BAK (Zymaxid), and same-concentration BAK alone exhibited antifungal activity in vitro. Moxifloxacin (MOX) or gatifloxacin without BAK-as well as trimethoprim, vancomycin, and chloramphenicol-had no effect. 1% PI and ILs had the highest efficacy/toxicity ratios (>1), and Polytrim was species dependent. Subfungicidal concentrations of Polytrim reduced adhesion of C. albicans to Kontur contact lenses. Gamma-irradiated corneas showed enhanced resistance to fungal invasion. CONCLUSIONS Of antibiotic preparations already in use for bacterial prophylaxis after KPro surgery, Polytrim is a commonly used antibiotic with antifungal effects mediated by both PMB and BAK and may be sufficient for prophylaxis. PI as a 1% solution seems to be promising as a long-term antifungal agent. Choline-undecanoate IL is effective and virtually nontoxic and warrants further development.
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15
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Liu J, Harissi-Dagher M. Comparison of outcomes in patients with and without soft contact lens wear following Boston keratoprosthesis type 1. Can J Ophthalmol 2021; 57:154-160. [PMID: 34058143 DOI: 10.1016/j.jcjo.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the rate of long-term complications in Boston keratoprosthesis type 1 (KPro) patients with and without soft contact lens wear (SCL). METHODS A chart review was performed on patients who underwent KPro type 1 surgery from January 2008 to June 2018 performed by a single surgeon at the University of Montreal Hospital Centre. Ninety-nine KPro patients (114 eyes) were separated into group 1 (patients with SCL) and group 2 (patients without SCL) at 1 and 5 years. Survival at 1- and 5-year follow-ups is defined as the absence of complications: corneal melts, leaks, retroprosthetic membrane, infectious keratitis, sterile vitritis, endophthalmitis, and KPro extrusion. RESULTS The mean SCL retention duration was 3.17 years. Overall, the survival distribution of both groups was not significantly different. At 1 year, group 1 achieved a higher KPro survival rate (75.11%) than group 2 (61.39%; p = 0.248). At 5 years, group 1 had a lower survival rate (49.11%) than group 2 (65.22%; p = 0.127). Although not statistically significant, the percentage of individual complications was higher in group 2 at 1 year (p = 0.3040) and lower in group 2 at 5 years (p = 0.6089) compared with group 1. CONCLUSION The mean SCL retention duration in our study was longer than previously reported. Long-term SCL does not significantly decrease the rate of complications. A prospective study is warranted to further examine the outcomes of long-term SCL wear.
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Affiliation(s)
- Jiaru Liu
- Department of Ophthalmology, University of Montreal Hospital Centre, Montreal, Que..
| | - Mona Harissi-Dagher
- Department of Ophthalmology, University of Montreal Hospital Centre, Montreal, Que
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16
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Ross C, Syed B, Pak J, Jhanji V, Yamaki J, Sharma A. Stability Evaluation of Extemporaneously Compounded Vancomycin Ophthalmic Drops: Effect of Solvents and Storage Conditions. Pharmaceutics 2021; 13:pharmaceutics13020289. [PMID: 33672310 PMCID: PMC7926595 DOI: 10.3390/pharmaceutics13020289] [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] [Received: 02/04/2021] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
Vancomycin is the drug of choice for methicillin-resistant Staphylococcus aureus keratitis and other ocular infections. Vancomycin ophthalmic drops are not commercially available and require compounding. The present study was designed to investigate the stability of vancomycin ophthalmic drops in normal saline, phosphate-buffered saline (PBS), and balanced salt solution (BSS) while stored at room temperature or under refrigeration. Vancomycin ophthalmic drops (50 mg/mL) were aseptically prepared from commercially available intravenous powder using PBS, BSS, and saline. Solutions were stored at room temperature and in a refrigerator for 28 days. The vancomycin stability was tested by a microbiology assay and high-performance liquid chromatography HPLC analysis immediately after formulation and at days 7, 14, and 28 after storage at room temperature or under refrigeration. The pH, turbidity was also tested. Vancomycin formulations in PBS, BSS and normal saline had initial pH of 5; 5.5; 3 respectively. The formulation in PBS developed turbidity and a slight decrease in pH upon storage. Microbiological assay did not show any change in zone of inhibition with any of the formulation upon storage either at room temperature or under refrigeration. HPLC analysis did not detect any decrease in vancomycin concentration or the accumulation of degraded products in any of the formulations upon storage either at room temperature or under refrigeration. Vancomycin ophthalmic drops prepared using PBS, BSS, and normal saline were stable up to the tested time point of 28 days, irrespective of their storage temperature.
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Affiliation(s)
- Christopher Ross
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
| | - Basir Syed
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
| | - Joanna Pak
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
| | - Vishal Jhanji
- Department of Ophthalmology School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Jason Yamaki
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
| | - Ajay Sharma
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
- Correspondence: ; Tel.: +1-714-516-5498
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17
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Kanu LN, Niparugs M, Nonpassopon M, Karas FI, de la Cruz JM, Cortina MS. Predictive factors of Boston Type I Keratoprosthesis outcomes: A long-term analysis. Ocul Surf 2020; 18:613-619. [DOI: 10.1016/j.jtos.2020.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 12/31/2022]
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18
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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: 33] [Impact Index Per Article: 8.3] [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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19
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Zhu BB, Zhou J, Zheng J, Zhang Y, Wan T, Huang XD, Lin L, Jin XM. Corneal graft melting: a systematic review. Int J Ophthalmol 2020; 13:493-502. [PMID: 32309189 DOI: 10.18240/ijo.2020.03.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/20/2019] [Indexed: 12/22/2022] Open
Abstract
Corneal graft melting is a severe complication of keratoplasty. This review is to summarize the incidence, the pathogenesis, the risk factors, the prognosis and the prevention of corneal graft melting after keratoplasty. We systematically searched PubMed, Web of Science and WanFang database to retrieve potentially eligible articles about relevant clinical reports and animal experiments. We read the full texts to identify eligible articles. The selection of studies and data extraction were performed independently by two reviewers. In conclusion, the pathogenesis of corneal graft melting is complicated, and many risk factors are closely related to corneal graft melting. Analysis of pathogenesis and risk factors of corneal graft melting can facilitate the development of targeted therapies to better guide clinical practice.
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Affiliation(s)
- Bin-Bin Zhu
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Jie Zhou
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Jiao Zheng
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Yue Zhang
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Ting Wan
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Dan Huang
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Lin Lin
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Xiu-Ming Jin
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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20
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Marchand M, Harissi-Dagher M. Recurrent preseptal cellulitis in Boston keratoprosthesis type II implantation for ocular Stevens-Johnson syndrome. Can J Ophthalmol 2019; 55:e59-e61. [PMID: 31712017 DOI: 10.1016/j.jcjo.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/01/2019] [Accepted: 07/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Marchand
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Que..
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21
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Harissi-Dagher M, Slim E. [Boston keratoprosthesis type 1]. J Fr Ophtalmol 2019; 42:295-302. [PMID: 30857801 DOI: 10.1016/j.jfo.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 11/26/2022]
Abstract
Penetrating keratoplasty is the most commonly performed tissue transplant in the world. However, its success depends on the health of the ocular surface and the intact immune privilege of the eye. In the absence of these two conditions, corneal transplants have an increased failure rate and result in corneal blindness. For more than two hundred years, researchers have been trying to find the best design of the artificial cornea in order to address these cases of severe corneal blindness. Despite previous difficulties, interest in the field has recently been revived, and considerable progress has been made over the last 20 years, to the point where the keratoprosthesis is now considered a primary procedure for some indications and is no longer always a surgery of last resort. In this review, we describe the global and personal experience with Boston keratoprosthesis type 1. It is a relatively new treatment for severe corneal blindness in the context of multiple failed corneal transplants and high-risk conditions. In the last decade, changes in the design, surgical technique, and postoperative management have increased the success rate and popularity of the Boston keratoprosthesis and decreased its complications substantially, making it a safe and effective alternative for certain corneal pathologies. However, some complications persist and require management to improve the visual prognosis of patients with corneal blindness.
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Affiliation(s)
- M Harissi-Dagher
- Centre hospitalier de l'université de Montréal, département d'ophtalmologie, 1000 St-Denis, Montréal, Québec, H2X 0C1 Canada; Département ophtalmologie, centre hospitalier de l'université de Montréal, 1000 St-Denis, Montréal, Québec, H2X 0C1 Canada
| | - E Slim
- Centre hospitalier de l'université de Montréal, département d'ophtalmologie, 1000 St-Denis, Montréal, Québec, H2X 0C1 Canada; Fellow en cornée et maladies du segment antérieur de l'université de Montréal, 1000 St-Denis, Montréal, Québec, H2X 0C1 Canada.
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22
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Paschalis EI, Taniguchi EV, Chodosh J, Pasquale LR, Colby K, Dohlman CH, Shen LQ. Blood Levels of Tumor Necrosis Factor Alpha and Its Type 2 Receptor Are Elevated in Patients with Boston Type I Keratoprosthesis. Curr Eye Res 2019; 44:599-606. [PMID: 30632412 DOI: 10.1080/02713683.2019.1568500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose: Boston keratoprosthesis (KPro) patients are prone to glaucoma even with well-controlled intraocular pressure (IOP). Recent experimental data have shown that soluble tumor necrosis factor alpha (TNF-α) after ocular injury may contribute to progressive retinal damage and subsequent glaucoma. This study evaluates the blood plasma levels of soluble TNF-α, TNF receptors 1 (TNFR1) and 2 (TNFR2), and leptin in patients with Boston type I KPro. Methods: Venous blood samples were collected from KPro patients with glaucoma (KPro G, n = 19), KPro patients without glaucoma (KPro NoG, n = 12), primary angle closure glaucoma without KPro (PACG, n = 13), and narrow angles without glaucoma or KPro (NA, n = 21). TNF-α, TNFR1, TNFR2, and leptin levels were quantified using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) was assessed using the Westergren test. Patients with underlying autoimmune conditions or diabetes were excluded from the study. Results: All groups had similar age, body mass index (BMI), IOP, and ESR (p ≥ 0.11). The mean time from KPro surgery to blood draw was 5.3 ± 3.7 years. Compared to NA patients (0.72 ± 0.3 pg/ml), KPro G and KPro NoG patients had higher blood plasma levels of TNF-α (1.18 ± 0.58 pg/ml, p = 0.006; 1.16 ± 0.50 pg/ml, p = 0.04, respectively). Similarly, KPro G patients had higher blood plasma levels of TNFR2 (2768 ± 1368 pg/ml) than NA patients (2020 ± 435 pg/ml, p = 0.048). In multivariate analysis, KPro status remained positively associated with TNF-α levels (β = 0.36; 95% confidence intervals [CI]: 0.14-0.58; p = 0.002) and TNFR2 levels (β = 458.3; 95% CI: 32.8-883.7; p = 0.035) after adjusting for age, gender, BMI, glaucoma status, and ESR. TNFR1 and leptin levels were not significantly different in the study groups. Conclusions: We detected elevated serum levels of TNF-α and TNFR2 in KPro patients. Longitudinal studies are needed to establish TNF-α and TNFR2 as serum biomarkers related to KPro surgery. Abbreviations: BCVA: best corrected visual acuity; BMI: body mass index; CDR: cup-to-disc ratio; EDTA: ethylenediaminetetraacetic acid; ELISA: enzyme-linked immunosorbent assay; ESR: erythrocyte sedimentation rate; HVF: Humphrey visual field; IOP: intraocular pressure; KPro G: keratoprosthesis with glaucoma; KPro NoG: keratoprosthesis without glaucoma; KPro: keratoprosthesis; MD: mean deviation; NA: narrow angle; non-KPro: without keratoprosthesis; PACG: primary angle closure glaucoma; RNFL: retinal nerve fiber layer; TNF-α: tumor necrosis factor alpha; TNFR1: tumor necrosis factor receptor 1; TNFR2: tumor necrosis factor receptor 2.
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Affiliation(s)
- Eleftherios I Paschalis
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,c Disruptive Technology Laboratory, Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Elise V Taniguchi
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,d Department of Ophthalmology , Universidade Federal de Sao Paulo , Sao Paulo , Brazil
| | - James Chodosh
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,c Disruptive Technology Laboratory, Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Louis R Pasquale
- e Department of Ophthalmology , Icahn School of Medicine, Mount Sinai Hospital , New York , NY , USA
| | - Kathryn Colby
- f Department of Ophthalmology , University of Chicago , Chicago , IL , USA
| | - Claes H Dohlman
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA
| | - Lucy Q Shen
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA
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Li L, Jiang H, Wang LQ, Huang YF. Experimental study on the biocompatibility of keratoprosthesis with improved titanium implant. Int J Ophthalmol 2018; 11:1741-1745. [PMID: 30450302 DOI: 10.18240/ijo.2018.11.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 09/27/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate whether hydroxyapatite (HAp) coating can improve keratoprosthesis (KPro) implant biointegration, ultimately to decrease the risk of implant-associated complications. METHODS The modified titanium implant was designed and prepared for artificial cornea. The titanium implant was treated with sandblasting and hydroxyapatite coating by acid-base two-step method. Surface was analyzed by scanning electron microscopy (SEM), KPro implants coated with HAp and KPro implant sandblasted were implanted in rabbits. Tissue adhesion to the implant was assessed and compared to an unmodified implant by histopathology (HE), transmission electron microscopy (TEM) and SEM. RESULTS SEM demonstrated successful deposition of HAp on titanium implant sandblasted (HA/SB-Ti). The hydroxyapatite coatings caused enhancement of keratocyte proliferation compared with unmodified implant surfaces. HAp coating significantly increased adhesion forces. HAp coating of implants reduced the inflammatory response around the KPro implants in vivo. CONCLUSION HAp-coated surfaces for use in titanium KPro implant greatly enhanced adherence of the titanium KPro implant in the rabbit cornea.
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Affiliation(s)
- Li Li
- Department of Ophthalmology, the 88th Hospital of Chinese People's Liberation Army, Taian 271000, Shandong Province, China
| | - Hua Jiang
- Department of Ophthalmology, Jinan Military General Hospital, Jinan 250031, Shandong Province, China
| | - Li-Qiang Wang
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yi-Fei Huang
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Johnson D, Robert MC, Bouhout S, Harissi-Dagher M. Vitritis after Boston Keratoprosthesis Type 1 Implantation. ACTA ACUST UNITED AC 2018; 2:1050-1055. [DOI: 10.1016/j.oret.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 11/16/2022]
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Pelletier JS, Barone SB, Capriotii JA. Keratoprosthesis prophylaxis: is it time for a paradigm shift? Clin Ophthalmol 2018; 12:1785-1788. [PMID: 30254417 PMCID: PMC6140746 DOI: 10.2147/opth.s178622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Boston Type I Keratoprosthesis has been improving in both design and safety since its inception. Due to particular features inherent in the Boston Type I Keratoprosthesis eye and certain aspects of the ocular surface, special attention is required to maintain these implanted devices. There is currently a prominent role for keratoprosthesis prophylaxis; it is designed to prevent infectious complications like keratitis and endophthalmitis. This standard-of-care therapy has anecdotally been shown to improve outcomes; however, it has not been examined in the setting of controlled clinical trials. Moreover, concerns remain with the chronic utilization of topical antibiotics in that they may engender antibiotic resistance and select for opportunistic populations to establish a foothold on the ocular surface. We believe and introduce the idea that there is merit in exploring other compounds besides antibiotics for prophylaxis such as antiseptics like povidone-iodine. Specifically developed formulations of povidone-iodine may prove useful in both improving keratoprosthesis safety and simultaneously mitigating concerns regarding antibiotic resistance.
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Affiliation(s)
- J S Pelletier
- Department of Ophthalmology, Veloce BioPharma LLC, Fort Lauderdale, FL, USA, .,Department of Ophthalmology, Plessen Ophthalmology Consultants, Christiansted, VI, USA, .,Department of Ophthalmology, Ocean Ophthalmology Group, Miami, FL, USA,
| | - S B Barone
- Department of Ophthalmology, Veloce BioPharma LLC, Fort Lauderdale, FL, USA,
| | - J A Capriotii
- Department of Ophthalmology, Veloce BioPharma LLC, Fort Lauderdale, FL, USA, .,Department of Ophthalmology, Plessen Ophthalmology Consultants, Christiansted, VI, USA,
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Dinh TN, Hou S, Park S, Shalek BA, Jeong KJ. Gelatin Hydrogel Combined with Polydopamine Coating to Enhance Tissue Integration of Medical Implants. ACS Biomater Sci Eng 2018; 4:3471-3477. [PMID: 31131316 DOI: 10.1021/acsbiomaterials.8b00886] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Soft tissue integration of medical implants is important to prevent bacterial infection and implant failure. A bioadhesive that forms firm binding between the implant and the surrounding tissue and facilitates the wound-healing process will be a great tool to establish the desired tissue-implant integration. In this project, we introduce a novel method that can be used to enhance integration between any implant material and any tissue using an enzyme-crosslinked gelatin hydrogel combined with polydopamine (PDA) coating. PDA coating was shown to enhance the binding between the gelatin hydrogel and three model implant materials - aluminum, poly(methyl methacrylate) (PMMA) and titanium. When combined with the gelatin hydrogel, pig cornea tissue adhered more strongly to the PDA coated surfaces than to the uncoated surfaces. The enzyme-crosslinked gelatin hydrogel was non-cytotoxic to human dermal fibroblasts and it also allowed the cells to adhere and proliferate. Altogether, the results indicate that the combination of PDA coating with gelatin hydrogel can be used to enhance the integration of various medical implants.
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Affiliation(s)
- Thanh N Dinh
- Department of Chemical Engineering, University of New Hampshire, Durham, NH 03824
| | - Shujie Hou
- Department of Chemical Engineering, University of New Hampshire, Durham, NH 03824
| | - Shiwha Park
- Department of Chemical Engineering, University of New Hampshire, Durham, NH 03824
| | - Benjamin A Shalek
- Department of Chemical Engineering, University of New Hampshire, Durham, NH 03824
| | - Kyung Jae Jeong
- Department of Chemical Engineering, University of New Hampshire, Durham, NH 03824
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Biofilm Formation on Bandage Contact Lenses Worn by Patients with the Boston Type 1 Keratoprosthesis: A Pilot Comparison Study of Prophylactic Topical Vancomycin 15 mg/mL and Linezolid 0.2%. Eye Contact Lens 2018; 44 Suppl 1:S106-S109. [DOI: 10.1097/icl.0000000000000337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Gibbons A, Leung EH, Haddock LJ, Medina CA, Fernandez V, Parel JMA, Durkee HA, Amescua G, Alfonso EC, Perez VL. Long-term outcomes of the aphakic snap-on Boston type I keratoprosthesis at the Bascom Palmer Eye Institute. Clin Ophthalmol 2018; 12:331-337. [PMID: 29497273 PMCID: PMC5818861 DOI: 10.2147/opth.s144403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine the indications, long-term clinical and visual outcomes, and complications of the aphakic snap-on type I Boston keratoprosthesis (KPro). Design Retrospective, non-comparative case series. Methods Forty-five eyes of 43 patients with type I aphakic snap-on KPros with at least 1 year of follow-up were included. The past medical histories, preoperative indications, best-corrected visual acuities (BCVAs), postoperative complications, and retention rates were analyzed. Results The most common indication for KPro implantation was a failed corneal graft (89%). The mean preoperative BCVA was count fingers–hand motion (2.14±0.45 logarithm of minimum angle of resolution [logMAR]), which initially improved to 20/200 (1.04±0.85 logMAR; P<0.0001). At the last examination, 24 eyes (53%) maintained some visual gain, 22% retained their preoperative visual acuity, and 24% lost vision due to postoperative events and underlying ocular comorbidities. Postoperative complications included retroprosthetic membranes (8/45, 18%), corneal melts (5/45, 11%), glaucoma progression (6/45, 13%), and endophthalmitis or sterile vitritis (6/45, 13%). The KPro retention rate was 89%, with a mean follow-up of 51 months. The mean BCVA at the last visit was 20/1,400 (1.82±0.92 logMAR). Conclusion Most patients experienced improved visual acuity after the implantation of the aphakic, snap-on type I KPro; however, the visual gains were not sustained over time, correlating with the onset of postoperative complications.
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Affiliation(s)
- Allister Gibbons
- Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL
| | - Ella H Leung
- Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL
| | - Luis J Haddock
- Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL
| | - Carlos A Medina
- Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL
| | - Viviana Fernandez
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Jean-Marie A Parel
- Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL.,Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Heather A Durkee
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Guillermo Amescua
- Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL
| | - Eduardo C Alfonso
- Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL
| | - Victor L Perez
- Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL.,Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Perez VL, Leung EH, Berrocal AM, Albini TA, Parel JM, Amescua G, Alfonso EC, Ali TK, Gibbons A. Impact of Total Pars Plana Vitrectomy on Postoperative Complications in Aphakic, Snap-On, Type 1 Boston Keratoprosthesis. Ophthalmology 2017; 124:1504-1509. [PMID: 28528012 DOI: 10.1016/j.ophtha.2017.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Victor L Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| | - Ella H Leung
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jean Marie Parel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo C Alfonso
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Tayyeba K Ali
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Allister Gibbons
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Ghezzi CE, Marelli B, Omenetto FG, Funderburgh JL, Kaplan DL. 3D Functional Corneal Stromal Tissue Equivalent Based on Corneal Stromal Stem Cells and Multi-Layered Silk Film Architecture. PLoS One 2017; 12:e0169504. [PMID: 28099503 PMCID: PMC5242458 DOI: 10.1371/journal.pone.0169504] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022] Open
Abstract
The worldwide need for human cornea equivalents continues to grow. Few clinical options are limited to allogenic and synthetic material replacements. We hypothesized that tissue engineered human cornea systems based on mechanically robust, patterned, porous, thin, optically clear silk protein films, in combination with human corneal stromal stem cells (hCSSCs), would generate 3D functional corneal stroma tissue equivalents, in comparison to previously developed 2D approaches. Silk film contact guidance was used to control the alignment and distribution of hCSSCs on RGD-treated single porous silk films, which were then stacked in an orthogonally, multi-layered architecture and cultured for 9 weeks. These systems were compared similar systems generated with human corneal fibroblasts (hCFs). Both cell types were viable and preferentially aligned along the biomaterial patterns for up to 9 weeks in culture. H&E histological sections showed that the systems seeded with the hCSSCs displayed ECM production throughout the entire thickness of the constructs. In addition, the ECM proteins tested positive for keratocyte-specific tissue markers, including keratan sulfate, lumican, and keratocan. The quantification of hCSSC gene expression of keratocyte-tissue markers, including keratocan, lumican, human aldehyde dehydrogenase 3A1 (ALDH3A1), prostaglandin D2 synthase (PTDGS), and pyruvate dehydrogenase kinase, isozyme 4 (PDK4), within the 3D tissue systems demonstrated upregulation when compared to 2D single silk films and to the systems generated with the hCFs. Furthermore, the production of ECM from the hCSSC seeded systems and subsequent remodeling of the initial matrix significantly improved cohesiveness and mechanical performance of the constructs, while maintaining transparency after 9 weeks.
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Affiliation(s)
- Chiara E. Ghezzi
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Benedetto Marelli
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Fiorenzo G. Omenetto
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - James L. Funderburgh
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - David L. Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
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Persistently Vitreous Culture-Positive Exogenous Fungal Endophthalmitis. Am J Ophthalmol 2016; 172:45-50. [PMID: 27644590 DOI: 10.1016/j.ajo.2016.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical settings, microbiological isolates, and best-corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis. DESIGN Retrospective consecutive case series. METHODS Setting: Tertiary referral center. PATIENT POPULATION Sixteen eyes of 16 patients with at least 2 consecutive positive vitreous cultures between 1981 and 2015. INTERVENTIONS Intravitreal antifungal injection, pars plana vitrectomy (PPV). MAIN OUTCOME MEASURE Clinical settings, microbiologic isolates, BCVA. RESULTS The most common clinical settings were after cataract surgery (9/16, 56%), glaucoma surgery (4/16, 25%), and trauma (2/16, 13%). The most common single fungal isolate was Candida (4/16, 25%), but 75% of all isolates were molds. Treatment for presumed bacterial endophthalmitis was given initially in 14 patients (88%). All patients underwent a vitrectomy during the course of their treatment, and all received intravitreal or systemic antifungal therapy. The mean initial BCVA was 1.76 ± 0.9 logMAR (Snellen equivalent ≈20/1200), and the mean final BCVA was 1.84 ± 1.2 logMAR (≈20/1400, P = .83). The 9 patients (56%) who had intraocular lens (IOL) and capsular bag removals had better final BCVAs than those who did not (P = .011). The BCVAs were similar in eyes with yeast and mold (P = .37). The visual acuity at the last follow-up was ≥20/40 in 13% (2/16), ≥20/400 in 50% (8/16), and no light perception in 25% (4/16). CONCLUSIONS Candida was the single most common isolate, but the majority of isolates were molds. Eyes managed with PPV and removal of the IOL and capsular bag had better visual outcomes. Persistently culture-positive fungal endophthalmitis was associated with poor final visual acuities.
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Sevgi DD, Fukuoka H, Afshari NA. 20 Years of Advances in Keratoprosthesis. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Infections in Ocular Prosthesis. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Degradation of silk films in multipocket corneal stromal rabbit models. J Appl Biomater Funct Mater 2016; 14:e266-76. [PMID: 27230452 DOI: 10.5301/jabfm.5000274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The need for human cornea tissues continues to grow as an alternative option to donor tissues. Silk protein has been successfully used as a substrate to engineer corneal epithelium and stroma in vitro. Herein, we investigated the in vivo response and the effect of silk crystalline structure (beta sheet) on degradation rate of silk films in rabbit multipocket corneal models. METHODS Three different surgical techniques (peripheral-median P-M, central-superficial C-S, central-deep C-D) were used to assess the in vivo response as well as the degradation profile of silk films with low, medium and high beta sheet (crystalline) content at 2 and 3 months after surgery. RESULTS Approach C-D showed signs of sample degradation without inflammation, with one single incision and a pocket created by flushing air two thirds deep in the corneal stroma. In comparison, approaches P-M and C-S with multiple incisions presented manually dissected surgical pockets resulted in inflammation and possible extrusion of the samples, respectively. Low beta sheet samples lost structural integrity at 2 months after surgery C-D, while medium and high beta sheet content films showed initial evidence of degradation. CONCLUSIONS The in vivo response to the silk films was dependent on the location of the implant and pocket depth. Crystallinity content in silk films played a significant role in the timing of material degradation, without signs of inflammation and vascularization or changes in stromal organization.
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Fungal Infections After Boston Type 1 Keratoprosthesis Implantation: Literature Review and In Vitro Antifungal Activity of Hypochlorous Acid. Cornea 2016; 34:1599-605. [PMID: 26488624 DOI: 10.1097/ico.0000000000000639] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the current literature describing cases of fungal keratitis and endophthalmitis after Boston keratoprosthesis (KPro) implantation and to characterize the antifungal activity of 0.01% hypochlorous acid against medically relevant fungi. METHODS A literature review of fungal keratitis or endophthalmitis in KPro patients from January 2001 to April 2015, and an in vitro time kill assay characterizing the fungicidal activity of 0.01% hypochlorous acid against fungi causing ocular infections. RESULTS Fifteen publications, predominantly retrospective case series, were identified. Infection rates after KPro implantation ranged from 0.009 to 0.02 fungal infections per patient-year of follow-up. The largest single-surgeon series reported an incidence of 2.4% for fungal endophthalmitis during a 10-year period. Causative organisms included both yeasts and molds. Outcomes were favorable if infections were caught early and treated appropriately; less favorable outcomes were reported in developing countries where fungal species are endemic and resources are limited. 0.01% hypochlorous acid is rapidly fungicidal, reducing the number of viable yeast cells or mold conidia by at least 99.99% within 60 seconds. The antifungal activity extended to all molds (Acremonium kiliense, Aspergillus flavus, Aspergillus fumigatus, Fusarium solani, and Mucor indicus) and yeast species (Candida albicans and Candida parapsilosis) tested. CONCLUSIONS Fungal infections remain a lifelong concern in patients after KPro implantation. There is a growing need for a standard antifungal prophylaxis regimen, especially in the developing world. The rapid broad-spectrum in vitro fungicidal activity of 0.01% hypochlorous acid against all fungi tested makes it an attractive candidate as an antifungal prophylaxis in KPro patients.
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Keratoprosthesis: A Review of Recent Advances in the Field. J Funct Biomater 2016; 7:jfb7020013. [PMID: 27213461 PMCID: PMC4932470 DOI: 10.3390/jfb7020013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/04/2016] [Accepted: 05/13/2016] [Indexed: 12/24/2022] Open
Abstract
Since its discovery in the years of the French Revolution, the field of keratoprostheses has evolved significantly. However, the path towards its present state has not always been an easy one. Initially discarded for its devastating complications, the introduction of new materials and the discovery of antibiotics in the last century gave new life to the field. Since then, the use of keratoprostheses for severe ocular surface disorders and corneal opacities has increased significantly, to the point that it has become a standard procedure for corneal specialists worldwide. Although the rate of complications has significantly been reduced, these can impede the long-term success, since some of them can be visually devastating. In an attempt to overcome these complications, researchers in the field have been recently working on improving the design of the currently available devices, by introducing the use of new materials that are more biocompatible with the eye. Here we present an update on the most recent research in the field.
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Salvador-Culla B, Jeong KJ, Kolovou PE, Chiang HH, Chodosh J, Dohlman CH, Kohane DS. Titanium Coating of the Boston Keratoprosthesis. Transl Vis Sci Technol 2016; 5:17. [PMID: 27152247 PMCID: PMC4855478 DOI: 10.1167/tvst.5.2.17] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/29/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose We tested the feasibility of using titanium to enhance adhesion of the Boston Keratoprosthesis (B-KPro), ultimately to decrease the risk of implant-associated complications. Methods Cylindrical rods were made of poly(methyl methacrylate) (PMMA), PMMA coated with titanium dioxide (TiO2) over a layer of polydopamine (PMMATiO2), smooth (Ti) and sandblasted (TiSB) titanium, and titanium treated with oxygen plasma (Tiox and TiSBox). Topography and surface chemistry were analyzed by scanning electron microscopy (SEM), atomic force microscopy (AFM), and X-ray photoelectron spectroscopy (XPS). Adhesion force between rods and porcine corneas was measured ex vivo. Titanium sleeves, smooth and sandblasted, were inserted around the stem of the B-KPro and implanted in rabbits. Tissue adhesion to the stem was assessed and compared to an unmodified B-Kpro after 1 month. Results X-ray photoelectron spectroscopy demonstrated successful deposition of TiO2 on polydopamine-coated PMMA. Oxygen plasma treatment did not change the XPS spectra of titanium rods (Ti and TiSB), although it increased their hydrophilicity. The materials did not show cell toxicity. After 14 days of incubation, PMMATiO2, smooth titanium treated with oxygen plasma (Tiox), and sandblasted titanium rods (TiSB, TiSBox) showed significantly higher adhesion forces than PMMA ex vivo. In vivo, the use of a TiSB sleeve around the stem of the B-KPro induced a significant increase in tissue adhesion compared to a Ti sleeve or bare PMMA. Conclusions Sandblasted titanium sleeves greatly enhanced adherence of the B-KPro to the rabbit cornea. This approach may improve adhesion with the donor cornea in humans as well. Translational Relevance This approach may improve adhesion with donor corneas in humans.
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Affiliation(s)
- Borja Salvador-Culla
- Department of Ophthalmology Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA ; Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA ; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kyung Jae Jeong
- Department of Chemical Engineering, University of New Hampshire, Durham, NH, USA
| | - Paraskevi Evi Kolovou
- Department of Ophthalmology Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Homer H Chiang
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA ; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - James Chodosh
- Department of Ophthalmology Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Claes H Dohlman
- Department of Ophthalmology Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel S Kohane
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA ; Department of Ophthalmology Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Durand ML, Ennis SC, Baker JN, Camuso JM, McEachern KM, Kotton CN, Lewis GD, Garcia JP, MacGillivray TE. Topical Polymyxin-Trimethoprim Prophylaxis May Decrease the Incidence of Driveline Infections in Patients With Continuous-Flow Left Ventricular Assist Devices. Artif Organs 2016; 41:169-175. [DOI: 10.1111/aor.12726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/25/2015] [Accepted: 01/14/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Marlene L. Durand
- Infectious Disease Unit, Department of Medicine; Massachusetts General Hospital; MA Boston USA
| | - Stephanie C. Ennis
- Department of Cardiac Surgery; Massachusetts General Hospital; MA Boston USA
| | - Joshua N. Baker
- Department of Cardiothoracic Surgery; Missouri Baptist Medical Center; St. Louis MO USA
| | - Janice M. Camuso
- Department of Cardiac Surgery; Massachusetts General Hospital; MA Boston USA
| | | | - Camille N. Kotton
- Infectious Disease Unit, Department of Medicine; Massachusetts General Hospital; MA Boston USA
| | - Gregory D. Lewis
- Cardiology Division; Massachusetts General Hospital; MA Boston USA
- Department of Medicine; Massachusetts General Hospital; Boston MA
| | - Jose P. Garcia
- Department of Cardiac Surgery; Massachusetts General Hospital; MA Boston USA
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Williamson SL, Cortina MS. Boston type 1 keratoprosthesis from patient selection through postoperative management: a review for the keratoprosthetic surgeon. Clin Ophthalmol 2016; 10:437-43. [PMID: 27041986 PMCID: PMC4798197 DOI: 10.2147/opth.s83677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For the anterior segment surgeon, the implantation of Boston type 1 keratoprosthesis is a multistep process that begins with careful patient selection. Success depends on thorough preoperative evaluation, detailed surgical planning, and frequent postoperative follow-up. New practice patterns have emerged for each of these phases as the international experience with keratoprosthesis grows. This review details special considerations that can improve outcomes and also allow surgeons to consider its use in challenging patient populations at each step.
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Affiliation(s)
- Samantha L Williamson
- Department of Ophthalmology, Kaiser Permanente Mid-Atlantic Medical Group, Baltimore, MD, USA
| | - M Soledad Cortina
- Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
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Scanning Electron Microscopic Analysis of Biofilm Formation in Explanted Human Boston Type I Keratoprostheses. Cornea 2016; 35:25-9. [PMID: 26562818 DOI: 10.1097/ico.0000000000000674] [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 To describe the morphological distribution of host tissue and microbial biofilms on the intraocular surfaces of Boston type I keratoprostheses (KPros) explanted because of corneal melt. METHODS Retrospective study of scanning electron microscopy (SEM) images from 4 explanted Boston type I KPros composed of polymethylmethacrylate and titanium. SEM images of KPro-associated ocular surfaces were reviewed for the presence of inflammatory cells, microbes, and/or biofilm formation. One sterile type I KPro was also imaged to serve as a (device only) control. RESULTS All 4 KPros were explanted because of culture-negative, clinically "sterile" donor corneal melt with impending KPro extrusion. In all cases, the rough, irregular surfaces of the device harbored more adherent corneal epithelium and stromacytes, inflammatory cells, and bacteria than the smooth, polished surface of the KPro optic. Two KPros showed not only evidence of prior bacterial colonization but marked biofilm formation. CONCLUSIONS SEM images of explanted KPros explanted for "sterile" corneal melt demonstrated evidence of biofilm formation despite negative donor corneal cultures and the absence of clinical suspicion for infection. These results suggest that "sterile" corneal melt may be due to inflammatory host responses to low microbial burdens as seen in biofilms and/or released antigens after antibiotic-induced lysis. There was increased adherence of host tissue cells and microbial biofilms on the nonpolished surfaces of the KPro. Polishing the intraocular polymethylmethacrylate and titanium KPro surfaces may decrease microbial adhesion and biofilm formation in human subjects with KPros, but what impact this will have on rates of postoperative endophthalmitis is unknown.
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Odorcic S, Sabeti S, Haas W, Durand ML, Dohlman CH. Fungal Infections in Boston Keratoprosthesis Patients: Lessons Learned and Novel Developments on the Horizon. Semin Ophthalmol 2016; 31:71-84. [DOI: 10.3109/08820538.2015.1114871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Duignan ES, Ní Dhubhghaill S, Malone C, Power W. Long-term visual acuity, retention and complications observed with the type-I and type-II Boston keratoprostheses in an Irish population. Br J Ophthalmol 2015; 100:1093-7. [PMID: 26628625 DOI: 10.1136/bjophthalmol-2015-307443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/25/2015] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the outcomes of the type-I and type-II Boston keratoprostheses in a single Irish centre. METHODS A retrospective chart review of keratoprosthesis implantations carried out in our institution from November 2002 to March 2014 was performed. All procedures were performed by a single surgeon (WP). RESULTS Thirty-four keratoprosthesis implantations were carried out in 31 patients with a mean follow-up of 42±31 months (range 2-110 months). Seventeen patients were female (54.8%) and 14 were male (45.2%). The majority of keratoprostheses implanted were type-I (31/34, 91.2%), and three were type-II (3/34, 8.8%). Twenty-nine patients (85.3%) had an improvement in distance best-corrected visual acuity (BCVA) from baseline. Fifty per cent (17/34) of patients had a best-ever BCVA of at least 6/12. Eighteen patients (64.3%) retained a BCVA of at least 6/60 at 1 year. Over the course of follow-up, six keratoprostheses were explanted from six eyes of five patients, one of which was a type-II keratoprosthesis. Twenty-six patients (76.5%) developed postoperative complications. Complications included retroprosthetic membrane (18 patients, 52.9%), an exacerbation or new diagnosis of glaucoma (6 patients, 17.6%), endophthalmitis (5 patients, 14.7%) and retinal detachment (2 patients, 5.9%). CONCLUSIONS These data demonstrate excellent visual acuity and retention outcomes in a cohort with a long follow-up period in a single centre. Complications remain a considerable source of morbidity. These outcomes provide further evidence for the long-term stability of type-I and type-II Boston keratoprostheses in the management of patients in whom a traditional graft is likely to fail.
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Affiliation(s)
- E S Duignan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - S Ní Dhubhghaill
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - C Malone
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - W Power
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Schallhorn JM, Rose-Nussbaumer J. Current Concepts in the Management of Unique Post-keratoplasty Infections. CURRENT OPHTHALMOLOGY REPORTS 2015; 3:184-191. [PMID: 26618075 DOI: 10.1007/s40135-015-0075-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As corneal transplantation has evolved, the spectrum of post-surgical infection has changed and often presents a diagnostic and therapeutic challenge. Lamellar techniques hold the potential of improved outcomes and decreased post-operative complications, however, they create a lamellar interface, which is a potential space for sequestration of infectious organisms. In addition, while keratoprosthesis offers vision to patients who are poor candidates for traditional keratoplasty, infectious complications can be severe and sight threatening. Although antimicrobials remain the mainstay of treatment, definitive management often requires surgical intervention.
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Affiliation(s)
- Julie M Schallhorn
- Department of Ophthalmology, Casey Eye Institute, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA, TEL: (503) 494-8311
| | - Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation/University of California San Francisco, Department of Optometry, University of California-Berkeley, 513 Parnassus S334, San Francisco, CA 94143, USA, TEL: (415) 502-2666
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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: 22] [Impact Index Per Article: 2.4] [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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Navas A, Hernandez‐Camarena JC, Serna‐Ojeda JC, Ramirez‐Miranda A, Graue‐Hernández EO. Boston type I keratoprosthesis assisted with intraprosthetic amniotic membrane (AmniotiKPro sandwich technique). Acta Ophthalmol 2015; 93:e87-8. [PMID: 24797302 DOI: 10.1111/aos.12423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alejandro Navas
- Department of Cornea and Refractive Surgery Instituto de Oftalmologia ‘Conde de Valenciana’ Mexico City Mexico
| | - Julio C. Hernandez‐Camarena
- Department of Cornea and Refractive Surgery Instituto de Oftalmologia ‘Conde de Valenciana’ Mexico City Mexico
| | - Juan Carlos Serna‐Ojeda
- Department of Cornea and Refractive Surgery Instituto de Oftalmologia ‘Conde de Valenciana’ Mexico City Mexico
| | - Arturo Ramirez‐Miranda
- Department of Cornea and Refractive Surgery Instituto de Oftalmologia ‘Conde de Valenciana’ Mexico City Mexico
| | - Enrique O. Graue‐Hernández
- Department of Cornea and Refractive Surgery Instituto de Oftalmologia ‘Conde de Valenciana’ Mexico City Mexico
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The Boston keratoprosthesis 2014: a step in the evolution of artificial corneas. SPEKTRUM DER AUGENHEILKUNDE 2015. [DOI: 10.1007/s00717-014-0240-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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