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Xu G, Qi H, He Q, Chen M, Fu J, Wang Q, Chen B, Yang QH, Huang Y, Wei S, Wang L. Predicting visual outcomes in keratoprosthesis surgery with critical flicker fusion frequency, B-scan, visual electrophysiology and endoscopy. Br J Ophthalmol 2024:bjo-2024-325719. [PMID: 39153832 DOI: 10.1136/bjo-2024-325719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/20/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This study evaluates the predictive power of the critical flicker fusion frequency (CFF) test for visual outcomes in keratoprosthesis (KPro) candidates, comparing its accuracy with B-scan ultrasound, flash visual evoked potentials (fVEP) and endoscopy. METHODS The study included 42 patients (42 eyes) scheduled for KPro surgery with a median follow-up period of 6 months. The receiver operating characteristic curve identified the cut-off threshold for CFF in the model development study (17 eyes). All patients in the comparison study (25 eyes) underwent preoperative assessments including trichromatic CFF (red, green and yellow), B-scan ultrasound, fVEP and perioperative endoscopy. Results were classified as either favourable or unfavourable predictors of visual outcomes based on predefined criteria. Sensitivity and specificity of each assessment were calculated based on postoperative best-corrected visual acuity (BCVA)≥20/200. The Bland-Altman test assessed the consistency between CFF-predicted BCVA and actual BCVA. RESULTS Among the trichromatic CFF tests, the yellow-CFF (yCFF) exhibited the highest area under the curve value of 0.97 and a cut-off threshold at 10 Hz for predicting postoperative BCVA≥20/200 (p<0.05). yCFF achieved 90% sensitivity and 80% specificity in predicting satisfactory postoperative outcomes. Endoscopy had 80% sensitivity and 80% specificity, B-scan showed 70% sensitivity and 60% specificity, and fVEP had 75% sensitivity and 40% specificity. yCFF showed a mean bias of 0.091 logarithm of the minimum angle of resolution (logMAR) in postoperative prediction. CONCLUSIONS The CFF test provides robust visual function evaluation in KPro candidates. It demonstrates superior predictive accuracy for visual prognosis compared with routine ophthalmologic examinations, such as B-scan ultrasonography, fVEP and endoscopy.
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Affiliation(s)
- Guangcan Xu
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haolan Qi
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qianwei He
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingxiong Chen
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Junxia Fu
- Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qun Wang
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Biyue Chen
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Qing Hua Yang
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yifei Huang
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Liqiang Wang
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
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Liasis A, Franco E, Eldib A, Handley S, Scanga HL, Nischal KK. The influence of congenital corneal opacity on ERGs obtained using an abbreviated protocol. Ophthalmic Genet 2023; 44:6-10. [PMID: 36541570 DOI: 10.1080/13816810.2022.2149817] [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: 12/24/2022]
Abstract
BACKGROUND Visual electrophysiology may be used to assess visual potential in infants with congenital corneal opacities (CCO). It is essential to recognize confounding effects from these opacities on the flash electroretinogram (ERG). METHODS ERGs were recorded in awake children employing skin electrodes placed at the lower eyelid crease, both referred to a midfrontal electrode (Fz). A hand-held stimulator was used to present a mixed rod-cone and a dim white stimulus. Recordings were carried out before and after penetrating keratoplasty (PK), when performed. RESULTS Five infants under the age of 12 months with visually significant CCO were evaluated. In all cases, initial ERGs employing the mixed rod-cone stimulus showed well-defined a-wave with reduced amplitude b-wave. Reduction of stimulus intensity resulted in an increase in the b-wave and normalization of the b:a ratio from 1.1 (range 0.7 to 1.3) to 2.8 (range 1.5 to 4.3). In three cases who underwent PK, the postoperative ERGs recorded with a mixed rod-cone stimulus were normal in waveform shape with a mean b:a ratio of 2.0 (range 1.7 to 3.0). CONCLUSION Selective reduction of the scotopic bright flash ERG b-wave is typically caused by retinal dysfunction that is post-phototransduction or inner retinal. In infants with CCO, scotopic ERGs to bright flashes can show a reduced b:a ratio that improves or normalizes either after PK or stimulus intensity reduction. The study highlights that media opacity can contribute to the generation of an ERG with reduced b-wave in the absence of inner retinal dysfunction.
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Affiliation(s)
- Alkiviades Liasis
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Italy
| | - Elena Franco
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amgad Eldib
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Italy
| | - Sian Handley
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hannah L Scanga
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ken K Nischal
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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3
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Silva LD, Berezovsky A, Salomão SR, Ferraz NN, Verna C, de Souza Soares T, de Oliveira LA. Impact of keratoprosthesis implantation on retinal and visual pathway function assessed by electrophysiological testing. Graefes Arch Clin Exp Ophthalmol 2023; 261:1627-1637. [PMID: 36633667 DOI: 10.1007/s00417-022-05961-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/23/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To investigate the impact of Boston Type I Keratoprosthesis (BI-Kpro) implantation on retinal and visual pathway function, respectively, assessed by full-field electroretinography (ERG) and visually evoked potentials (VEPs). METHODS This is a prospective interventional longitudinal study, and patients with BI-Kpro implantation were assessed preoperatively and at 3 and 12 months after surgery. ERG, flash, and pattern-reversal VEPs (15' and 60' checks) along with visual acuity (VA) were performed. RESULTS A total of 13 patients (24 to 88 years of age) were included. Mean baseline VA (logMAR) improved from 2.30 to 1.04 at 3 months and to 1.00 at 12 months. Flash VEPs were normal in 6 (46%) patients and in 10 (77%) patients at the 12-month follow-up. PVEP was non-detectable in all patients preoperatively for both check sizes. For 15' check size, 6 (46%) patients showed responses after 3 and 12 months except for 1 patient with normal responses at 12 months with the remaining non-detectable. For 60' checks, 11 (85%) patients had responses 3 months after surgery with only 9 (70%) showing responses at 12 months. Abnormal full-field ERGs were found in all patients preoperatively. Amplitude improvement was found in 10 (77%) patients from baseline to 3 months and in 8 (62%) patients from the 3- to the 12-month follow-up. CONCLUSIONS In this small cohort of patients with BI-Kpro implantation, a remarkable improvement on visual function quantitatively assessed by electrophysiological testing was found in the majority of cases. Visual electrophysiological testing can contribute to objectively assess functional outcomes in this population.
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Affiliation(s)
- Luzia Diegues Silva
- Departamento de Oftalmologia E Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 806, SP, 04023-062, São Paulo, Brazil
| | - Adriana Berezovsky
- Departamento de Oftalmologia E Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 806, SP, 04023-062, São Paulo, Brazil
| | - Solange Rios Salomão
- Departamento de Oftalmologia E Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 806, SP, 04023-062, São Paulo, Brazil
| | - Nívea Nunes Ferraz
- Departamento de Oftalmologia E Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 806, SP, 04023-062, São Paulo, Brazil
| | - Carina Verna
- Departamento de Oftalmologia E Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 806, SP, 04023-062, São Paulo, Brazil
| | - Tarciana de Souza Soares
- Departamento de Oftalmologia E Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 806, SP, 04023-062, São Paulo, Brazil
| | - Lauro Augusto de Oliveira
- Departamento de Oftalmologia E Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 806, SP, 04023-062, São Paulo, Brazil.
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Ortiz-Morales G, Loya-Garcia D, Colorado-Zavala MF, Gomez-Elizondo DE, Soifer M, Srinivasan B, Agarwal S, Rodríguez-Garcia A, Perez VL, Amescua G, Iyer G. The evolution of the modified osteo-odonto-keratoprosthesis, its reliability, and long-term visual rehabilitation prognosis: An analytical review. Ocul Surf 2022; 24:129-144. [DOI: 10.1016/j.jtos.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
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Silva LD, Santos A, Hirai F, Allemann N, Berezovsky A, Salomão SR, Oliveira PRCD, Andrade G, Maia A, Sousa LBD, Oliveira LAD. B-scan ultrasound, visual electrophysiology and perioperative videoendoscopy for predicting functional results in keratoprosthesis candidates. Br J Ophthalmol 2020; 106:32-36. [PMID: 33093153 DOI: 10.1136/bjophthalmol-2020-316962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS We analysed the ability of B-scan ultrasound, ocular electrophysiology testing and videoendoscopic examination for predicting visual prognosis in Boston Type 1 keratoprosthesis (KPro-1) candidates. Indirect anatomical and electrophysiological findings and results from direct endoscopic evaluations were correlated with postoperative functional data. METHODS In this prospective and interventional study, we included 13 individuals who had previously been indicated for Kpro-1 surgery. All subjects underwent preoperative screening, including ophthalmic evaluation, B-scan ultrasound, electrophysiological testing, and perioperative intraocular videoendoscopic evaluation (VE). B-scan ultrasound, electrophysiological testing, and VE evaluation results were categorised as favourable or unfavourable predictors of postoperative functional results according to predefined criteria. The predictability values of B-scan ultrasound, electrophysiological testing, and VE prognostication were calculated based on the visual acuity level achieved. RESULTS All surgeries and perioperative VEs were uneventful. Preoperative best-corrected visual acuity (BCVA) ranged from light perception to counting fingers. The 1-year postoperative BCVA was better than 20/200 (satisfactory visual acuity result) in 10 eyes (76.9%) and 20/40 or better in 5 eyes (38.5%). B-scan ultrasound presented a positive predictive value (PPV) of 85.7% for satisfactory postoperative visual acuity, electroretinography showed a PPV of 66.7%, and visual evoked potential presented a PPV of 66.7%. The perioperative VE PPV of a negative finding for satisfactory visual acuity was 100%. CONCLUSIONS Fundoscopic visualisation by intraocular VE is a minimally invasive procedure that can be used to predict functional outcomes in keratoprosthesis candidates. This technique demonstrated better prognostication in keratoprosthesis candidates than B-scan ultrasound and electrophysiological testing.
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Affiliation(s)
- Luzia Diegues Silva
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, United States of America
| | - Albert Santos
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Flavio Hirai
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Norma Allemann
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, United States of America
| | - Adriana Berezovsky
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Solange Rios Salomão
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Gabriel Andrade
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - André Maia
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Luciene Barbosa de Sousa
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
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Berg BI, Peyer M, Kuske L, Augello M, Schötzau A, Steineck M, Deibel W, Mathys D, Jürgens P, Kunz C, Goldblum D. Comparison of an Er: YAG laser osteotome versus a conventional drill for the use in osteo- odonto-keratoprosthesis (OOKP). Lasers Surg Med 2019; 51:531-537. [PMID: 30645014 DOI: 10.1002/lsm.23053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The osteo-odonto-kerato-prosthesis (OOKP) procedure is a complex, multi-stage, multidisciplinary surgical intervention for the treatment of severe corneal blindness. One step of the OOKP consists of creating a precise hole into a tooth in which an optic cylinder is subsequently inserted; its shape must ensure a perfect watertight fit. The Er: YAG laser (L) used in this study is part of CARLO®, the first laser osteotome that enables surgical planning based on computed tomography data, robot guidance, and a precise execution of laser cuts in teeth and bone tissue, using laser photoablation rather than conventional mechanical methods. The purpose of this study was to assess whether the Er: YAG laser is non-inferior compared to a conventional drill. METHODS Thirty-two bovine incisors were grounded to a thickness of 1.5 mm. In 16 teeth, a 3.5 mm hole was drilled progressively into each tooth, using dental burs (B) of increasing diameter that were attached to a fixed drill machine. In the other 16 teeth, a hole was created using an Er: YAG laser at a wavelength of 2.94 µm (Part of CARLO®). In seven teeth of each group, the cylinder was inserted and fixated with polymethylmethacrylate (PMMA) bone cement. In the remaining seven teeth of each group, the cylinder was inserted without fixation material (press-fit). After bonding and drying, all specimens were stored in water until force measurements were recorded using a uniaxial traction machine. The force required to move the optical cylinder out of the hole in the tooth was measured using an Instron 3344 testing system. Scanning electron microscope (SEM) and light microscope (LM) visualization of the holes created with the laser and the drill were performed in two teeth (SEM)/four teeth (LM) per method. RESULTS Significant differences (P < 0.001) were found for the following parameters: B PMMA versus B press-fit; B PMMA versus L press-fit; L PMMA versus B press-fit; L PMMA-L press-fit. This shows that PMMA bone cement fixation is superior to press-fit. No significant differences were found between B PMMA-L PMMA (P = 0.93) and B press-fit-L press-fit (P = 0.83). The SEM pictures showed a smoother surface using L. CONCLUSIONS The laser cut holes were as strong as bur-drilled holes, although SEM pictures showed a smoother surface of the laser cut holes. Hence, laser osteotomes open the possibility to custom fit the hole exactly to the width of the cylinder, which represents a potential advantage of the laser over the conventional bur. Lasers Surg. Med. 51:531-537, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Britt-Isabelle Berg
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Switzerland
| | - Michael Peyer
- Advanced Osteotomy Tools AG (AOT), Basel, Switzerland
| | - Lorenz Kuske
- Department of Ophthalmology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Marcello Augello
- Department of Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Schötzau
- Department of Ophthalmology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Markus Steineck
- Department of Dentistry, University Basel, Basel, Switzerland
| | | | - Daniel Mathys
- Swiss Nanoscience Institute (SNI), Nano Imaging Lab, Basel, Bio-Pharma Centre, Basel, Switzerland
| | - Philipp Jürgens
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Switzerland.,Advanced Osteotomy Tools AG (AOT), Basel, Switzerland
| | - Christoph Kunz
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Switzerland
| | - David Goldblum
- Department of Ophthalmology, University Hospital Basel, University Basel, Basel, Switzerland
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Mermeklieva EA. Reference values of pattern reversal visual evoked potentials in Bulgarian population. Eur J Ophthalmol 2018; 29:600-605. [PMID: 30246542 DOI: 10.1177/1120672118802545] [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: 11/15/2022]
Abstract
AIMS The aim of this study is to evaluate pattern visual evoked potentials as an objective electrophysiological method and to create reference values for Bulgarian population. METHODS AND MATERIALS Standardized four-channel equipment 'Neuro-MEP 4' produced by 'Neurosoft' Company was used. A group of 47 healthy individuals (94 eyes) was studied. The stimulation was monocular, with a contrast-reversing pattern from black to white and vice versa. The investigation was performed with a three-channel recording with equipment adjustments according to the latest published ISCEV standard for pattern visual evoked potentials (2016). Based on a comprehensive overview of the available literature, a protocol of stimulating, amplifying and recording the obtained potentials has been created. The values of pattern visual evoked potential wave components, P50, N75, P100, N145 and P200, were measured. RESULTS Based on a created protocol, latency and amplitudes of the individual wave components of pattern visual evoked potentials were obtained. The results were statistically processed to create reference values of all pattern visual evoked potentials components, which are used as reference of the laboratory for the Bulgarian population. CONCLUSION Pattern visual evoked potentials are objective electrophysiological method which is used to diagnose and monitor numerous ophthalmological and neurological diseases as well as for objective study of visual acuity and visual field in children and aggravation. The creation of pattern visual evoked potentials reference values for the Bulgarian population and its implementation in clinical practice are of particular importance for studying the visual analyser function.
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Affiliation(s)
- Elena A Mermeklieva
- Clinic of Ophthalmology, Aleksandrovska University Hospital, Sofia, Bulgaria
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8
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Stolowy N, Callet M, Beylerian M, Hoffart L, Yin GHW. [The Boston keratoprosthesis in the management of corneal blindness: Indications and limitations]. J Fr Ophtalmol 2018; 41:642-649. [PMID: 30170706 DOI: 10.1016/j.jfo.2017.11.039] [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: 10/25/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Keratoprostheses offer a therapeutic alternative to patients with bilateral corneal blindness who cannot undergo corneal allograft. The goal of this work was to evaluate the indications and limitations of Boston keratoprosthesis. MATERIALS AND METHODS Seven patients underwent unilateral implantation of a Boston type I keratoprosthesis between December 2012 and November 2016. The following data were collected: surgical indication, preoperative visual acuity, postoperative visual acuity at D1, D7, D30, 6 months and 12 months, complications and postoperative treatment. RESULTS The mean age of implantation was 58.7±23.4 years. The surgical indications included 1 case of congenital bilateral aniridia, 2 cases of chemical burn and 4 graft decompensations after multiple keratoplasties. Preoperative visual acuity was limited to "light perception" in 6 cases and "hand motion" in one case. A gain in visual acuity was observed in 4 patients, which corresponded to a mean gain of 1.53 logMAR at last follow-up. Postoperative visual acuity averaged 2.33 logMAR. All patients experienced an improvement in their quality of life and independence. DISCUSSION Patients should be selected carefully, favoring patients with a remaining functional potential and able to engage in close postoperative follow-up, in order to ensure the best possible treatment success. CONCLUSION Boston keratoprosthesis provides improved vision and improved quality of life for patients suffering from bilateral corneal blindness.
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Affiliation(s)
- N Stolowy
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
| | - M Callet
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - M Beylerian
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - L Hoffart
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - G Ho Wang Yin
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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Charoenrook V, Michael R, de la Paz MF, Temprano J, Barraquer RI. Comparison of long-term results between osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis. Ocul Surf 2018; 16:259-264. [DOI: 10.1016/j.jtos.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
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10
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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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11
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Charoenrook V, Michael R, de la Paz MF, Ding A, Barraquer RI, Temprano J. Osteokeratoprosthesis Using Tibial Bone: Surgical Technique and Outcomes. Ocul Surf 2016; 14:495-506. [PMID: 27503376 DOI: 10.1016/j.jtos.2016.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyze the anatomical and functional results of keratoprosthesis using tibial bone autograft. METHODS We reviewed 113 charts of patients who underwent tibial bone osteokeratoprothesis implantation at the Centro de Oftalmologia Barraquer. Kaplan-Meier survival curves with 95% confidence interval were calculated for functional success, defined as best corrected visual acuity (BCVA) ≥0.05 on the decimal scale, and for anatomical success, defined as retention of the keratoprosthesis lamina. Multivariate analysis was used to test the impact of clinical factors on anatomical and functional survival rates. RESULTS Based on Kaplan-Meier analyses, tibial bone keratoprosthesis 5-year and 10-year anatomical survival rates were 69.5% and 53.5%, respectively. Functional survival rate at 5 years was 33% and at 10 years was 19.2%. Considering primary diagnosis, chemical burn had better anatomical and functional survival rates than autoimmune or infectious diseases. Patient age did not have a significant effect on keratoprosthesis survival rates. About 48.7% of the patients who underwent surgery had complications: keratoprosthesis extrusion, glaucoma, retinal detachment and buccal mucosa necrosis were the most frequent ones. CONCLUSION Half of the patients with tibial bone KPro had retained the keratoprosthesis after 10 years post-surgery and one-fifth of them had visual acuity of 0.05 or better at the same period. Considering that these patients have no other way to recover their vision either because they have no canine tooth or their buccal or dental conditions are not adequate for OOKP, this modified surgery is their only hope.
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Affiliation(s)
- Victor Charoenrook
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain; Institut Universitari Barraquer, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ralph Michael
- Institut Universitari Barraquer, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Maria Fideliz de la Paz
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain; Institut Universitari Barraquer, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Angela Ding
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Rafael I Barraquer
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain; Institut Universitari Barraquer, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jose Temprano
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain
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12
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Avadhanam VS, Smith HE, Liu C. Keratoprostheses for corneal blindness: a review of contemporary devices. Clin Ophthalmol 2015; 9:697-720. [PMID: 25945031 PMCID: PMC4406263 DOI: 10.2147/opth.s27083] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
According to the World Health Organization, globally 4.9 million are blind due to corneal pathology. Corneal transplantation is successful and curative of the blindness for a majority of these cases. However, it is less successful in a number of diseases that produce corneal neovascularization, dry ocular surface and recurrent inflammation, or infections. A keratoprosthesis or KPro is the only alternative to restore vision when corneal graft is a doomed failure. Although a number of KPros have been proposed, only two devices, Boston type-1 KPro and osteo-odonto-KPro, have came to the fore. The former is totally synthetic and the latter is semi-biological in constitution. These two KPros have different surgical techniques and indications. Keratoprosthetic surgery is complex and should only be undertaken in specialized centers, where expertise, multidisciplinary teams, and resources are available. In this article, we briefly discuss some of the prominent historical KPros and contemporary devices.
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Affiliation(s)
- Venkata S Avadhanam
- Sussex Eye Hospital, Brighton, UK ; Brighton and Sussex Medical School, Brighton, UK
| | | | - Christopher Liu
- Sussex Eye Hospital, Brighton, UK ; Brighton and Sussex Medical School, Brighton, UK ; Tongdean Eye Clinic, Hove, UK
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Farias CC, Ozturk HE, Albini TA, Berrocal AM, Amescua G, Betancurt C, Parel JM, Oliveros MC, Gibbons A, Vargas JM, Perez VL. Use of intraocular video endoscopic examination in the preoperative evaluation of keratoprosthesis surgery to assess visual potential. Am J Ophthalmol 2014; 158:80-86.e2. [PMID: 24582996 DOI: 10.1016/j.ajo.2014.02.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the clinical utility of intraocular videoendoscopy examination for the evaluation of the retina and optic nerve in patients being considered for a Boston type I keratoprosthesis (KPro). DESIGN Interventional case series study. METHODS Ten patients with a history of corneal blindness caused by failed penetrating keratoplasty (PK) and inability to accurately assess visual potential were included in this study. Ophthalmologic examination, B-scan ultrasonography, and pars plana videoendoscopy were carried out to assess the retina and optic nerve before KPro. RESULTS Posterior segment examination was successfully used to evaluate the retina and optic nerve of all patients with opaque corneas. Out of 10 patients that underwent endoscopic examination, 3 (30%) were considered to be adequate candidates for KPro surgery and 7 (70%) were not. This was based on visualized retinal disease and/or optic nerve pathology. Of the 3 patients that underwent KPro surgery, all of them had a significant improvement of vision, including counting fingers to 20/100, hand motion to 20/5, and light perception to 20/80, as suggested by the endoscopy preoperative examination. No complications of the endoscopy procedure were observed. CONCLUSIONS This report demonstrates the successful use of intraocular videoendoscopy to rule out threats to a good visual outcome for patients being considered as candidates for KPro. Direct visualization of the posterior segment can be part of the preoperative algorithm in the decision process of performing a KPro surgery in patients when visual potential is questionable.
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Affiliation(s)
- Charles C Farias
- Department of Ophthalmology, 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; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Hilal E Ozturk
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, 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
| | - Audina M Berrocal
- Department of Ophthalmology, 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; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Carolina Betancurt
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, 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; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary C Oliveros
- Department of Ophthalmology, Cornea Service, Centro Oftalmologico de Valencia, Valencia, Venezuela
| | - Allister Gibbons
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jose M Vargas
- Department of Ophthalmology, Cornea Service, Centro Oftalmologico de Valencia, Valencia, Venezuela
| | - Victor L Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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de la Paz MF, Stoiber J, de Rezende Couto Nascimento V, de Toledo JA, Seyeddain O, Hitzl W, Grabner G, Barraquer RI, Michael R. Anatomical survival and visual prognosis of Boston type I keratoprosthesis in challenging cases. Graefes Arch Clin Exp Ophthalmol 2013; 252:83-90. [DOI: 10.1007/s00417-013-2481-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/23/2013] [Accepted: 09/25/2013] [Indexed: 11/30/2022] Open
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Abstract
The cornea, the clear window at the front of the eye, transmits light to the retina to enable vision. The corneal surface is renewed by stem cells located at the peripheral limbal region. These cells can be destroyed by a number of factors, including chemical burns, infections, and autoimmune diseases, which result in limbal stem cell deficiency (LSCD), a condition that can lead to blindness. Established therapy for LSCD based on ex vivo expanded limbal epithelial cells is currently at a stage of refinement. Therapy for LSCD is also rapidly evolving to include alternative cell types and clinical approaches as treatment modalities. In the present perspectives chapter, strategies to treat LSCD are discussed and advances in this important field of regenerative medicine are highlighted.
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Affiliation(s)
- Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
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