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Sunka KC, Ghosh A, Ganguly P, Chaudhuri BR, Dhara S. A new approach of aspheric intralamellar keratoprostheses optic design made with poly(2-hydroxy ethylmethacrylate) hydrogel. Biomed Phys Eng Express 2024; 10:045035. [PMID: 38714186 DOI: 10.1088/2057-1976/ad47fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 05/09/2024]
Abstract
Keratoprosthesis (KPro) is a surgical procedure largely confined to end-stage corneal blindness correction, where artificial cornea substitutes the native tissue. Though the problem of bio integration was addressed partially by strategic utilization of synthetic polymers and native tissue, major challenges like optical performance and design-associated post-operative complications of KPro were overlooked. Herein, a novel intralamellar KPro design is conceptualized to address these challenges using a light-transparent poly(2-hydroxy ethylmethacrylate) (pHEMA) hydrogel with good shape memory. pHEMA-based optics' theoretically modelled refractive surfaces for both phakic and aphakic conditions were investigated against the standard Navarro model and optimized to new aspheric geometries having high optical functionality utilizing the Zemax OpticStudio software. The optical clear aperture size standardized achieved a 15% improvement in the illumination field. The introduction of asphericity on the two refractive surfaces of the optic on both models resulted in substantial improvements in the spot spread confinement on the retina, spatial resolution, and Seidel aberration. The design simulation study shows that the developed materials' optical characteristics coupled with newly optimized refractive surface geometries can indeed deliver very high visual performance. Furthermore, the procedure can be adapted to analyze and optimize the optical performance of a KPro, intraocular lens, or contact lens.
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Affiliation(s)
- Krishna Chaitanya Sunka
- School of Medical Science and Technology Indian Institute of Technology Kharagpur West Bengal-721302, India
| | - Atriya Ghosh
- Volk Optical Inc. Mentor, OH 44060, United States of America
| | - Pranabendu Ganguly
- Advanced Technology Development Centre Indian Institute of Technology Kharagpur West Bengal-721302, India
| | | | - Santanu Dhara
- School of Medical Science and Technology Indian Institute of Technology Kharagpur West Bengal-721302, India
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Maugeri G, D’Amico AG, Federico C, Saccone S, D’Agata V, Musumeci G. Moderate Physical Activity Increases the Expression of ADNP in Rat Brain. Int J Mol Sci 2024; 25:4382. [PMID: 38673966 PMCID: PMC11050439 DOI: 10.3390/ijms25084382] [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: 03/14/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Activity-dependent neuroprotective protein (ADNP) is a neuroprotective protein essential for embryonic development, proper brain development, and neuronal plasticity. Its mutation causes the autism-like ADNP syndrome (also called the Helsmoortel-Van der Aa syndrome), characterized by neural developmental disorders and motor dysfunctions. Similar to the ADNP syndrome, the ADNP haploinsufficient mouse shows low synapse density, leading to motor and cognitive ability delays. Moderate physical activity (PA) has several neuroprotective and cognitive benefits, promoting neuronal survival, differentiation, neurogenesis, and plasticity. Until now, no study has investigated the effect of moderate exercise on ADNP expression and distribution in the rat brain. The aim of the current investigation was to study the effects of moderate exercise on the ADNP expression and neuronal activation measured by the microtubule protein β-Tubulin III. In pursuit of this objective, twenty-four rats were selected and evenly distributed into two categories: sedentary control rats and rats exposed to moderate physical activity on a treadmill over a span of 12 weeks. Our results showed that moderate PA increases the expression of ADNP and β-Tubulin III in the dentate gyrus (DG) hippocampal region and cerebellum. Moreover, we found a co-localization of ADNP and β-Tubulin III in both DG and cerebellum, suggesting a direct association of ADNP with adult neuronal activation induced by moderate PA.
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Affiliation(s)
- Grazia Maugeri
- Section of Anatomy, Histology and Movement Sciences, Department of Biomedical and Biotechnological Sciences, University of Catania, 95100 Catania, Italy; (G.M.); (G.M.)
| | | | - Concetta Federico
- Section of Animal Biology, Department of Biological, Geological and Environmental Sciences, University of Catania, 95123 Catania, Italy; (C.F.); (S.S.)
| | - Salvatore Saccone
- Section of Animal Biology, Department of Biological, Geological and Environmental Sciences, University of Catania, 95123 Catania, Italy; (C.F.); (S.S.)
| | - Velia D’Agata
- Section of Anatomy, Histology and Movement Sciences, Department of Biomedical and Biotechnological Sciences, University of Catania, 95100 Catania, Italy; (G.M.); (G.M.)
| | - Giuseppe Musumeci
- Section of Anatomy, Histology and Movement Sciences, Department of Biomedical and Biotechnological Sciences, University of Catania, 95100 Catania, Italy; (G.M.); (G.M.)
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Orive Bañuelos A, Fideliz de la Paz M, Feijóo Lera R, Santamaría Carro A, Martínez Grau A, Andollo Victoriano N, Etxebarria Ecenarro J. Transmucosal Boston Keratoprosthesis Type II in a Case of Severe Bilateral Chemical Burn. Cornea 2024; 43:261-264. [PMID: 37906002 DOI: 10.1097/ico.0000000000003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/08/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The purpose of this report was to describe a new alternative surgical technique combining oral mucosa and the Boston Keratoprosthesis type II (BKPro II) in a patient with severe chemical burn. METHODS We present a case of a 37-year-old man who suffered a severe bilateral chemical burn. Visual acuity was light perception and projection in both eyes. After many surgeries, including eyelid reconstruction, eyelashes electrolysis, and amniotic membrane transplants, he presented a corneal thinning in his right eye that was managed with an autologous oral mucosa graft. Considering the limited function of the eyelids, mild symblepharon, and dry ocular surface, we proposed the implantation of a BKPro II. The patient voiced his desire of avoiding complete tarsorrhaphy for better cosmesis. Osteo-odonto-keratoprosthesis or tibial bone keratoprothesis was also discarded at the patient's express wish. A year and a half later, the oral mucosa was transplanted, and once the ocular surface was stabilized, we lift the mucosa 270 degrees and performed the implantation of the BKPro II covering this device with the mucosa trephined avoiding the complete tarsorrhaphy and theraby modifying the standard procedure. RESULTS After 34 months of follow-up, the patient did not develop any complications, his visual acuity is stable (0.3 decimal), and funduscopic examination showed a pale optic disk, vascular tortuosity, and an epiretinal membrane that remains stable up to this period. CONCLUSIONS Transmucosal BKPro II may be considered as an alternative surgical technique for implant support in BKPro II carriers who want to improve their cosmesis avoiding, avoid complete tarsorrhaphy, and do not want to be exposed to dental or bone surgeries.
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Affiliation(s)
- Ana Orive Bañuelos
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
| | - María Fideliz de la Paz
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autónoma de Barcelona, Barcelona, Spain; and
| | - Raquel Feijóo Lera
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
| | - Alaitz Santamaría Carro
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
| | - Ainhoa Martínez Grau
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autónoma de Barcelona, Barcelona, Spain; and
| | - Noelia Andollo Victoriano
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country (UPV/ EHU), Leioa, Spain
| | - Jaime Etxebarria Ecenarro
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country (UPV/ EHU), Leioa, Spain
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Aoun T, Harissi-Dagher M. [Long-term visual outcomes of Boston type I keratoprosthesis in Canada]. J Fr Ophtalmol 2023; 46:1212-1221. [PMID: 37867123 DOI: 10.1016/j.jfo.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/11/2023] [Accepted: 07/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND/PURPOSE To evaluate long-term visual outcomes of Boston type I keratoprosthesis (KPro) surgery and identify risk factors for visual failure. METHODS Single surgeon retrospective cohort study including 85 eyes of 74 patients who underwent KPro implantation to treat severe ocular surface disease, including limbal stem cell deficiency, postinfectious keratitis, aniridia and chemical burns. Procedures were performed at the Centre hospitalier de l'Université de Montréal from October 2008 to May 2012. All patients with at least 5 years of follow-up were included in the analysis, including eyes with repeated KPro. Main outcome measures were visual acuity (VA), visual failure, defined as a sustained VA worse than the preoperative VA, postoperative complications, and device retention. RESULTS Mean follow-up was 7.2±1.3 years (±SD). Mean VA was 2.1±0.7 (logarithm of minimal angle resolution) preoperatively and 1.9±1.2 at last follow-up. In total, 2.4% of patients had VA better than 20/200 preoperatively vs. 36.5% at last follow-up. Maintenance of improved postoperative VA was seen in 61.8% of eyes at 7 years. Preoperative factors associated with visual failure were known history of glaucoma (HR=2.7 [1.2 to 5.9], P=0.02) and Stevens-Johnson syndrome (HR=7.3 [2.5 to 21.4], P<0.01). Cumulative 8-year complication rates were 38.8% retroprosthetic membrane formation, 25.9% hypotony, 23.5% new onset glaucoma, 17.6% retinal detachment, 8.2% device extrusion and 5.9% endophthalmitis. The majority (91.8%) of eyes retained the device 8 years after implantation. CONCLUSION Nearly two-thirds of patients exhibited improved VA 7 years after KPro implantation. Preoperative risk factors for visual failure were known glaucoma and Stevens-Johnson syndrome.
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Affiliation(s)
- T Aoun
- Faculté de médecine, université de Montréal, Montréal, Canada
| | - M Harissi-Dagher
- Centre hospitalier de l'université de Montréal (CHUM), Montréal, Canada.
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Bhujel B, Oh SH, Kim CM, Yoon YJ, Kim YJ, Chung HS, Ye EA, Lee H, Kim JY. Mesenchymal Stem Cells and Exosomes: A Novel Therapeutic Approach for Corneal Diseases. Int J Mol Sci 2023; 24:10917. [PMID: 37446091 DOI: 10.3390/ijms241310917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
The cornea, with its delicate structure, is vulnerable to damage from physical, chemical, and genetic factors. Corneal transplantation, including penetrating and lamellar keratoplasties, can restore the functions of the cornea in cases of severe damage. However, the process of corneal transplantation presents considerable obstacles, including a shortage of available donors, the risk of severe graft rejection, and potentially life-threatening complications. Over the past few decades, mesenchymal stem cell (MSC) therapy has become a novel alternative approach to corneal regeneration. Numerous studies have demonstrated the potential of MSCs to differentiate into different corneal cell types, such as keratocytes, epithelial cells, and endothelial cells. MSCs are considered a suitable candidate for corneal regeneration because of their promising therapeutic perspective and beneficial properties. MSCs compromise unique immunomodulation, anti-angiogenesis, and anti-inflammatory properties and secrete various growth factors, thus promoting corneal reconstruction. These effects in corneal engineering are mediated by MSCs differentiating into different lineages and paracrine action via exosomes. Early studies have proven the roles of MSC-derived exosomes in corneal regeneration by reducing inflammation, inhibiting neovascularization, and angiogenesis, and by promoting cell proliferation. This review highlights the contribution of MSCs and MSC-derived exosomes, their current usage status to overcome corneal disease, and their potential to restore different corneal layers as novel therapeutic agents. It also discusses feasible future possibilities, applications, challenges, and opportunities for future research in this field.
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Affiliation(s)
- Basanta Bhujel
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Se-Heon Oh
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Chang-Min Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Ye-Ji Yoon
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Young-Jae Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Ho-Seok Chung
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Eun-Ah Ye
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Hun Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Jae-Yong Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro, Songpa-Gu, Seoul 05505, Republic of Korea
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Fuest M, Jhanji V, Yam GHF. Molecular and Cellular Mechanisms of Corneal Scarring and Advances in Therapy. Int J Mol Sci 2023; 24:ijms24097777. [PMID: 37175482 PMCID: PMC10178104 DOI: 10.3390/ijms24097777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
On the basis of WHO global blindness data, it may be stated that 23 million people globally suffer from unilateral corneal blindness, while 4 [...].
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Affiliation(s)
- Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, 52074 Aachen, Germany
- Cornea Bank Aachen, RWTH Aachen University, 52074 Aachen, Germany
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Gary Hin-Fai Yam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Singapore Eye Research Institute, Singapore 169856, Singapore
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15213, USA
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Sun X, Qiao Y, Zhao L, Shi Z, Zhang X, Cao R, Zhou Q, Shi W. Application of Decellularized Porcine Sclera in Repairing Corneal Perforations and Lamellar Injuries. ACS Biomater Sci Eng 2022; 8:5295-5306. [PMID: 36454184 DOI: 10.1021/acsbiomaterials.2c00972] [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: 12/02/2022]
Abstract
Scleras are mainly used for the treatment of glaucoma, eyelid damage, and scleral ulcers. Given that the sclera and cornea collectively constitute the complete external structure of the eyeball and both have the same tissue and cell origin, we attempted to identify scleral materials to treat lamellar and penetrating corneal injuries. Based on research in our center, antigenic components in decellularized porcine sclera (DPS) were removed using a simplified decellularization method, leaving the collagen structure and active components undamaged. DPS preserved the mechanical properties and did not significantly inhibit the proliferation and replication of human corneal epithelial cells. In vivo, the graft epithelium healed well after lamellar and penetrating scleral grafting, and the graft thickness did not change evidently. DPS can resist suture traction during scleral transplantation and maintain anterior chamber stability until day 28 post-operatively, especially in penetrating repairs. No obvious immune rejection of lamellar or penetrating scleral grafts was found 28 days after DPS transplantation. This study shows that DPS could be used as an alternative material for the emergency repair of corneal perforations and lamellar injuries, representing another application of sclera.
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Affiliation(s)
- Xiuli Sun
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Yujie Qiao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Long Zhao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Zhen Shi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Xiaoyu Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Rui Cao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Qingjun Zhou
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, 5 Yan'erdao Road, Qingdao 266071, China
| | - Weiyun Shi
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jingsi Road, Jinan 271000, China
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Activity-Dependent Neuroprotective Protein (ADNP): An Overview of Its Role in the Eye. Int J Mol Sci 2022; 23:ijms232113654. [PMID: 36362439 PMCID: PMC9658893 DOI: 10.3390/ijms232113654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
Vision is one of the dominant senses in humans and eye health is essential to ensure a good quality of life. Therefore, there is an urgent necessity to identify effective therapeutic candidates to reverse the progression of different ocular pathologies. Activity-dependent neuroprotective protein (ADNP) is a protein involved in the physio-pathological processes of the eye. Noteworthy, is the small peptide derived from ADNP, known as NAP, which shows protective, antioxidant, and anti-apoptotic properties. Herein, we review the current state of knowledge concerning the role of ADNP in ocular pathologies, while providing an overview of eye anatomy.
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9
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Choi SY, Kim S, Park KM. Initial Healing Effects of Platelet-Rich Plasma (PRP) Gel and Platelet-Rich Fibrin (PRF) in the Deep Corneal Wound in Rabbits. Bioengineering (Basel) 2022; 9:bioengineering9080405. [PMID: 36004930 PMCID: PMC9405118 DOI: 10.3390/bioengineering9080405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
Platelet concentrates (PCs), including platelet-rich plasma (PRP) gel and platelet-rich fibrin (PRF), are autologous blood-derived biomaterials containing numerous growth factors. This study aimed to evaluate the initial healing effects of PRP gel and PRF on deep corneal wounds. Thirty-three eyes from New Zealand white rabbits were divided into four groups: group 1, lamellar keratectomy (LK); group 2, LK + commercial porcine small intestinal submucosal membrane (SIS); group 3, LK + SIS + PRP gel; and group 4, LK + SIS + PRF. Postoperative clinical and histological findings were observed for eight weeks. Group 1 showed no neovascularization during the observation period, and incompletely recovered with a thin cornea. Group 2 showed active healing through neovascularization, and a thick cornea was regenerated through the sufficient generation of myofibroblasts. Although group 3 showed a healing effect similar to that of group 2, angiogenesis and subsequent vessel regression were promoted, and corneal opacity improved more rapidly. In group 4, angiogenesis was promoted during initial healing; however, the incidence of complications, such as inflammation, was high, and myofibroblasts were hardly generated in the corneal stroma, which adversely affected remodeling. In conclusion, while PRP gel is a safe surgical material for promoting remodeling through vascular healing and myofibroblast production in deep corneal wounds, the use of PRF is not recommended.
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Affiliation(s)
- Seo-Young Choi
- Laboratory of Veterinary Ophthalmology, Department of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Soochong Kim
- Laboratory of Veterinary Pathology and Platelet Signaling, Department of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Kyung-Mee Park
- Laboratory of Veterinary Ophthalmology, Department of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Korea
- Correspondence: ; Tel.: +82-43-250-2985
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10
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Combined Therapy Using Human Corneal Stromal Stem Cells and Quiescent Keratocytes to Prevent Corneal Scarring after Injury. Int J Mol Sci 2022; 23:ijms23136980. [PMID: 35805991 PMCID: PMC9267074 DOI: 10.3390/ijms23136980] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Corneal blindness due to scarring is conventionally treated by corneal transplantation, but the shortage of donor materials has been a major issue affecting the global success of treatment. Pre-clinical and clinical studies have shown that cell-based therapies using either corneal stromal stem cells (CSSC) or corneal stromal keratocytes (CSK) suppress corneal scarring at lower levels. Further treatments or strategies are required to improve the treatment efficacy. This study examined a combined cell-based treatment using CSSC and CSK in a mouse model of anterior stromal injury. We hypothesize that the immuno-regulatory nature of CSSC is effective to control tissue inflammation and delay the onset of fibrosis, and a subsequent intrastromal CSK treatment deposited collagens and stromal specific proteoglycans to recover a native stromal matrix. Using optimized cell doses, our results showed that the effect of CSSC treatment for suppressing corneal opacities was augmented by an additional intrastromal CSK injection, resulting in better corneal clarity. These in vivo effects were substantiated by a further downregulated expression of stromal fibrosis genes and the restoration of stromal fibrillar organization and regularity. Hence, a combined treatment of CSSC and CSK could achieve a higher clinical efficacy and restore corneal transparency, when compared to a single CSSC treatment.
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11
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Wong YL, Liu S, Walkden A. Current Perspectives on Corneal Transplantation (Part 2). Clin Ophthalmol 2022; 16:647-659. [PMID: 35282168 PMCID: PMC8904263 DOI: 10.2147/opth.s349582] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
Disease of the cornea is the third leading cause of blindness worldwide. Corneal graft surgery is one of the most successful forms of solid organ transplantations in humans, with ever increasing developments in surgical technique. To date, approximately 4504 corneal transplants are performed in the UK each year. While full thickness transplantation was the most commonly performed keratoplasty over the last few decades, selective lamellar transplantation of the diseased layers of the cornea has been universally adopted. This comprehensive review aims to provide an updated synthesis on different types of corneal transplantations, their treatment outcomes, and the associated complications of each procedure both in adult and pediatric populations. In addition, we also present an up-to-date summary of the emerging therapeutic approaches that have the potential to reduce the demand for donor-dependent keratoplasty.
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Affiliation(s)
- Yee Ling Wong
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Siyin Liu
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew Walkden
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Correspondence: Andrew Walkden, Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK, Email
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A Broad Overview on Pituitary Adenylate Cyclase-Activating Polypeptide Role in the Eye: Focus on Its Repairing Effect in Cornea. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) is a neuropeptide with widespread distribution throughout the central and peripheral nervous system as well as in many other peripheral organs. It plays cytoprotective effects mediated mainly through the activation of specific receptors. PACAP is known to play pleiotropic effects on the eye, including the cornea, protecting it against different types of insult. This review firstly provides an overview of the anatomy of the cornea and summarizes data present in literature about PACAP’s role in the eye and, in particular, in the cornea, either in physiological or pathological conditions.
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13
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The Historical Development and an Overview of Contemporary Keratoprostheses. Surv Ophthalmol 2022; 67:1175-1199. [DOI: 10.1016/j.survophthal.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
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14
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Sikora B, Skubis-Sikora A, Prusek A, Gola J. Paracrine activity of adipose derived stem cells on limbal epithelial stem cells. Sci Rep 2021; 11:19956. [PMID: 34620960 PMCID: PMC8497478 DOI: 10.1038/s41598-021-99435-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022] Open
Abstract
Limbal stem cells deficiency (LSCD) is an eye disease caused by the loss of stem cells in the corneal limbus as a succession of an injury due physical, biological, or chemical agents. Current therapies of LSCD are focused on the transplantation of donor corneas or tissue equivalents produced from autologous limbal stem cells. Every year there are waiting millions of patients for the cornea transplantation all over the world and the list is growing due to the relatively low number of cornea donors. On the other hand, the transplantation of tissue or cells into the recipient’s body is associated with the higher risk of possible side effects. The possibility of the application of an indirect treatment using the properties of the paracrine activity of stem cells, would be beneficial for the patients with transplant failures. This study was to evaluate the paracrine effect of mesenchymal stem cells derived from adipose tissue (ADSC) on the viability of limbal epithelial stem cells (LESC). The paracrine effect was assessed by treating LESC with conditioned medium collected from ADSC culture. Cell viability, cytotoxicity, apoptosis and proliferation were evaluated using in vitro assays in standard conditions and induced inflammation. After the exposure to the examined conditions, the expression of genes related to pro- and anti- inflammatory factors was evaluated and compared to the secretion of selected cytokines by ELISA test. Moreover, the changes in LESC phenotype were assessed using of phenotype microarrays. Our findings suggest that paracrine activity of ADSC on LESC promotes its proliferation and has a potential role in mitigation of the adverse impact of inflammation induced by lipopolysaccharide.
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Affiliation(s)
- Bartosz Sikora
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, ul. Medyków 18, C2/103, 40-752, Katowice, Poland.
| | - Aleksandra Skubis-Sikora
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, ul. Medyków 18, C2/103, 40-752, Katowice, Poland
| | - Agnieszka Prusek
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, ul. Medyków 18, C2/103, 40-752, Katowice, Poland
| | - Joanna Gola
- Department of Molecular Biology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland
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15
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Application of mesenchymal stem cells in corneal regeneration. Tissue Cell 2021; 73:101600. [PMID: 34371292 DOI: 10.1016/j.tice.2021.101600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 12/13/2022]
Abstract
Due to delicate its structure, the cornea is susceptible to physical, chemical, and genetic damages. Corneal transplantation is the main treatment for serious corneal damage, but it faces significant challenges, including donor shortages and severe complications. In recent years, cell therapy is suggested as a novel alternative method for corneal regeneration. Regarding the unique characteristics of Mesenchymal stem cells including the potential to differentiate into discrete cell types, secretion of growth factors, mobilization potency, and availability from different sources; special attention has been paid to these cells in corneal engineering. Differentiation of MSCs into specialized corneal cells such as keratocytes, epithelial and endothelial cells is reported. Potential for Treatment of keratitis, reducing inflammation, and inhibition of neovascularization by MSCs, introducing them as novel agents for corneal repairing. In this review, various types of MSCs used to treat corneal injuries as well as their potential for restoring different corneal layers was investigated.
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16
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Schaub F, Matthaei M, Enders P, Siebelmann S, Hos D, Bachmann BO, Cursiefen C. [Treatment of vascularized high-risk eyes with a Boston keratoprosthesis]. Ophthalmologe 2021; 118:544-552. [PMID: 33730307 DOI: 10.1007/s00347-021-01356-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In severely compromised and vascularized high-risk eyes, the Boston keratoprosthesis procedure is often the last treatment option. The transparency of the optics is not impaired by endothelial immune reactions. METHODS This review article discusses relevant literature as well as our own data and experiences with the Boston keratoprosthesis in high-risk eyes. The relevant complications as well as the postoperative management are discussed. RESULTS In more than 60% of the high-risk eyes a long-term increase in visual acuity can be achieved. Keratoprosthesis retention rates show a variable span with reported mean 5‑year retention rates of 75%. The most common postoperative complications include the formation of a retroprosthetic membrane and keratolysis in up to 50% each. More than 70% of the eyes already suffer from (secondary) glaucoma preoperatively, so that glaucoma surgery is performed simultaneously in at least 20% of cases and in the postoperative course further antiglaucomatous surgery is necessary in up to 31%. Vitreoretinal complications include, in particular, sterile vitritis and infectious endophthalmitis but persistent hypotonia is also described in one third of patients. CONCLUSION The Boston keratoprosthesis is an alternative to conventional corneal replacement if the prognosis for allogeneic transplants is poor. Postoperative complications are common; therefore, postoperative management plays an important role. For vascularized high-risk eyes, however, it is often the only remaining option for visual rehabilitation.
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Affiliation(s)
- F Schaub
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
| | - M Matthaei
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - P Enders
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Glaucoma Imaging Center University of Cologne, Medizinische Fakultät, Universitätsklinik Köln, Köln, Deutschland
| | - S Siebelmann
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - D Hos
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Zentrum für Molekulare Medizin Köln, Universität zu Köln, Köln, Deutschland
| | - B O Bachmann
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - C Cursiefen
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Zentrum für Molekulare Medizin Köln, Universität zu Köln, Köln, Deutschland
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Avadhanam V, Ingavle G, Zheng Y, Kumar S, Liu C, Sandeman S. Biomimetic bone-like composites as osteo-odonto-keratoprosthesis skirt substitutes. J Biomater Appl 2020; 35:1043-1060. [PMID: 33174770 PMCID: PMC7917574 DOI: 10.1177/0885328220972219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Osteo-odonto-keratoprostheses, incorporating dental laminate material as an
anchoring skirt around a central poly(methyl methacrylate) (PMMA) optic, have
been used to replace the cornea for many years. However, there are many
intricacies associated with the use of autologous dental laminate material,
surgical complexity and skirt erosion. Tissue engineering approaches to bone
replacement may offer suitable alternatives in osteo-odonto-keratoprosthesis
(OOKP) surgery. In this study, a hydrogel polymer composite was investigated as
a synthetic substitute for the OOKP skirt. A novel high strength
interpenetrating network (IPN) hydrogel composite with nano-crystalline
hydroxyapatite (nHAp) coated poly (lactic-co-glycolic acid) PLGA microspheres
was created to mimic the alveo-dental lamina by employing agarose and
poly(ethylene glycol) diacrylate (PEGDA) polymers. The incorporation of nHAp
coated PLGA microspheres into the hybrid IPN network provide a micro-environment
similar to that of skeletal tissues and improve cellular response. Agarose was
used as a first network to encapsulate keratocytes/3T3 fibroblasts and PEGDA
(6000 Da) was used as a second network with varying concentrations (20 and 40 wt
%) to produce a strong and biocompatible scaffold. An increased concentration of
either agarose or PEG-DA and incorporation of nHAp coated PLGA microspheres led
to an increase in the elastic modulus. The IPN hydrogel combinations supported
the adhesion and proliferation of both fibroblast and ocular human keratocyte
cell types during in in-vitro testing. The cells endured the
encapsulation process into the IPN and remained viable at 1 week
post-encapsulation in the presence of nHAp coated microspheres. The material did
not induce significant production of inflammatory cytokine IL-6 in comparison to
a positive control (p < 0.05) indicating non-inflammatory
potential. The nHAp encapsulated composite IPN hydrogels are mechanically
strong, cell supportive, non-inflammatory materials supporting their development
as OOKP skirt substitutes using a new approach to dental laminate biomimicry in
the OOKP skirt material.
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Affiliation(s)
- Venkata Avadhanam
- Brighton and Sussex Medical School, Brighton, UK.,Bristol Eye Hospital, Bristol, UK
| | - Ganesh Ingavle
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK.,Symbiosis Centre for Stem Cell Research, Symbiosis International University, Pune, India
| | - Yishan Zheng
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Sandeep Kumar
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Christopher Liu
- Brighton and Sussex Medical School, Brighton, UK.,Sussex Eye Hospital, Brighton, UK.,Tongdean Eye Clinic, Hove, UK
| | - Susan Sandeman
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
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18
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Xie L, Ouyang C, Ji J, Wu J, Dong X, Hou C, Huang T. Construction of bioengineered corneal stromal implants using an allogeneic cornea-derived matrix. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 120:111673. [PMID: 33545838 DOI: 10.1016/j.msec.2020.111673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 01/12/2023]
Abstract
The bioengineering of corneal scaffolds that mimic native human cornea has attracted interest owing to the scarcity of donor corneas for the transplantation-based treatment of corneal blindness. However, an optimally engineered corneal tissue for clinical use has yet to emerge. Herein, human corneal tissues discarded during allogeneic corneal transplantation surgery were used to construct allogeneic cornea-derived matrix (ACM) scaffolds with favorable optical properties and structural strength. During scaffold fabrication, collagen and glycosaminoglycan levels were well preserved, while DNA decreased significantly. Scanning electron microscopy revealed the presence of fiber-like structures on the scaffold surface and specific structures featuring multiple interlaced lamellae in cross-sections. Moreover, corneal epithelial cells grown on the ACM formed a continuous multi-stratified epithelium with a strong expression of the corneal epithelial differentiation marker CK3/12, gap junction marker Connexin43, and stem-cell-specific marker p63α, while corneal stromal cells expressed the keratocyte-specific marker KERA and the adhesion marker integrin β1. When the ACM was implanted into rabbit corneal stromal pockets, the rabbit cornea remained transparent throughout the follow-up period. These results indicate that the construction of corneal stromal implants from discarded human corneal tissues may pave the way for the generation of high-quality corneal tissue for transplantation.
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Affiliation(s)
- Lijie Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Chen Ouyang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Jianping Ji
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Jing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Xiaojuan Dong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Chao Hou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Ting Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China.
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19
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Qin L, Gao H, Xiong S, Jia Y, Ren L. Preparation of collagen/cellulose nanocrystals composite films and their potential applications in corneal repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:55. [PMID: 32504216 DOI: 10.1007/s10856-020-06386-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
As the main component of the natural cornea, collagen (COL) has been widely applied to the construction of corneal repair materials. However, the applications of collagen are limited due to its poor mechanical properties. Cellulose nanocrystals (CNCs) possess excellent mechanical properties, optical transparency and good biocompatibility. Therefore, in this study, we attempted to introduce cellulose nanocrystals into collagen-based films to obtain corneal repair materials with a high strength. CNCs were incorporated at 1, 3, 5, 7 and 10 wt%. The physical properties of these composite films were characterized, and in vitro cell-based analyses were also performed. The COL/CNC films possessed better mechanic properties, and the introduction of CNCs did not affect the water content and light transmittance. The COL/CNC films demonstrated good biocompatibility toward rabbit corneal epithelial cells and keratocytes in vitro. Moreover, the collagen films with appropriate ration of CNCs effectively induced the migration of corneal epithelial cells and inhibited the myofibroblast differentiation of keratocytes. A collagen film with 7 wt% CNCs displayed the best combination of physical properties and biological performance in vitro among all the films. This study describes a nonchemical cross-linking method to enhance the mechanical properties of collagen for use in corneal repair materials and highlights potential application in corneal tissue engineering.
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Affiliation(s)
- Lanfeng Qin
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, 510006, China
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
| | - Huichang Gao
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
| | - Sijia Xiong
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Yongguang Jia
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Li Ren
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China.
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China.
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China.
- Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510005, China.
- Sino-Singapore International Joint Research Institute, Guangzhou, 510555, China.
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20
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Griffith M, Poudel BK, Malhotra K, Akla N, González-Andrades M, Courtman D, Hu V, Alarcon EI. Biosynthetic alternatives for corneal transplant surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1754798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- May Griffith
- Department of Ophthalmology, University of Montreal and Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC, Canada
| | - Bijay Kumar Poudel
- Department of Ophthalmology, University of Montreal and Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC, Canada
| | - Kamal Malhotra
- Department of Ophthalmology, University of Montreal and Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC, Canada
| | - Naoufal Akla
- Department of Ophthalmology, University of Montreal and Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC, Canada
| | - Miguel González-Andrades
- Department of Ophthalmology, Reina Sofia University Hospital and University of Cordoba, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - David Courtman
- Department of Medicine, University of Ottawa, and Scientist, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Victor Hu
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, London, UK
| | - Emilio I. Alarcon
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
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21
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Systematic Review and Meta-Analysis of the Medium- and Long-Term Outcomes of the Boston Type 1 Keratoprosthesis. Cornea 2020; 38:1465-1473. [PMID: 31403526 DOI: 10.1097/ico.0000000000002098] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The Boston type 1 keratoprosthesis (KPro), used in patients with high risk of corneal graft failure, is increasingly being used. However, the medium- to long-term outcomes are currently unclear. We analyzed the medium- (2-5 years) and long-term (>5 years) efficacy and safety of the Boston type 1 KPro in terms of visual outcomes, device retention, and postoperative complications. METHODS We last searched electronic databases (Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid MEDLINE Epub Ahead of Print, EMBASE, and CENTRAL) on March 31, 2018. Visual outcomes and device retention at 2 and 5 years, alongside postoperative complications, were primary outcome measures. RESULTS We identified 407 articles. Thirty studies were included in this systematic review and meta-analysis. The combined proportion of eyes with ≥6/60 vision was 62% at 2 years and 51% at 5 years. The combined retention rate was 88% at 2 years and 74% at 5 years. Retroprosthetic membrane (36.6%) and glaucoma (39.3%) were found to be the most common long-term complications. Very few studies showed visual outcomes or retention rates at 5 years, with results sparse and collectively not meaningful because of small patient numbers and ambiguous reporting of follow-up times. CONCLUSIONS The 2-year results indicate that there is a place for the Boston type 1 KPro in the management of corneal blindness. However, there is scarce evidence regarding its medium- and long-term efficacy and safety. The high rate of reported complications necessitates strict patient selection and stringent follow-up.
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22
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Bandeira F, Goh TW, Setiawan M, Yam GHF, Mehta JS. Cellular therapy of corneal epithelial defect by adipose mesenchymal stem cell-derived epithelial progenitors. Stem Cell Res Ther 2020; 11:14. [PMID: 31900226 PMCID: PMC6942321 DOI: 10.1186/s13287-019-1533-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/29/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Persistent epithelial defects (PED), associated with limbal stem cell deficiency (LSCD), require ocular surface reconstruction with a stable corneal epithelium (CE). This study investigated CE reformation using human adipose mesenchymal stem cells (ADSC), which derived epithelial progenitors via mesenchymal-epithelial transition (MET). Methods STEMPRO human ADSC were cultured with specific inhibitors antagonizing glycogen synthase kinase-3 and transforming growth factor-β signaling, followed by culture under a defined progenitor cell targeted-epithelial differentiation condition to generate epithelial-like cells (MET-Epi), which were characterized for cell viability, mesenchymal, and epithelial phenotypes using immunofluorescence and flow cytometry. Tissue-engineered (TE) MET-Epi cells on fibrin gel were transplanted to corneal surface of the rat LSCD model caused by alkali injury. Epithelial healing, corneal edema, and haze grading, CE formation were assessed by fluorescein staining, slit lamp bio-microscopy, anterior segment optical coherence tomography, and immunohistochemistry. Results CD73high/CD90high/CD105high/CD166high/CD14negative/CD31negative human ADSC underwent MET, giving viable epithelial-like progenitors expressing δNp63, CDH1 (E-cadherin), epidermal growth factor receptor, integrin-β4, and cytokeratin (CK)-5, 9. Under defined epithelial differentiation culture, these progenitors generated MET-Epi cells expressing cell junction proteins ZO1 and occludin. When transplanted onto rat corneal surface with LSCD-induced PED, TE-MET-Epi achieved more efficient epithelial healing, suppressed corneal edema, and opacities, when compared to corneas without treatment or transplanted with TE-ADSC. CE markers (CK3, 12, and CDH1) were expressed on TE-MET-Epi-transplanted corneas but not in other control groups. Conclusion Human ADSC-derived epithelial-like cells, via MET, recovered the CE from PED associated with LSCD. ADSC can be a viable adult stem cell source for potential autologous epithelial cell-based therapy for corneal surface disorders.
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Affiliation(s)
- Francisco Bandeira
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 20 College Road, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Federal University of São Paulo, Sao Paulo, Brazil
| | - Tze-Wei Goh
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 20 College Road, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Melina Setiawan
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 20 College Road, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Gary Hin-Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 20 College Road, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore. .,Eye-Academic Clinical Program, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore.
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 20 College Road, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore. .,Eye-Academic Clinical Program, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore. .,Singapore National Eye Centre, Singapore, Singapore. .,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore.
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23
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Fuchs S, Shariati K, Ma M. Specialty Tough Hydrogels and Their Biomedical Applications. Adv Healthc Mater 2020; 9:e1901396. [PMID: 31846228 PMCID: PMC7586320 DOI: 10.1002/adhm.201901396] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/23/2019] [Indexed: 02/06/2023]
Abstract
Hydrogels have long been explored as attractive materials for biomedical applications given their outstanding biocompatibility, high water content, and versatile fabrication platforms into materials with different physiochemical properties and geometries. Nonetheless, conventional hydrogels suffer from weak mechanical properties, restricting their use in persistent load-bearing applications often required of materials used in medical settings. Thus, the fabrication of mechanically robust hydrogels that can prolong the lifetime of clinically suitable materials under uncompromising in vivo conditions is of great interest. This review focuses on design considerations and strategies to construct such tough hydrogels. Several promising advances in the proposed use of specialty tough hydrogels for soft actuators, drug delivery vehicles, adhesives, coatings, and in tissue engineering settings are highlighted. While challenges remain before these specialty tough hydrogels will be deemed translationally acceptable for clinical applications, promising preliminary results undoubtedly spur great hope in the potential impact this embryonic research field can have on the biomedical community.
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Affiliation(s)
- Stephanie Fuchs
- Department of Biological and Environmental Engineering, Cornell University, Riley Robb Hall 322, Ithaca, NY, 14853, USA
| | - Kaavian Shariati
- Department of Biological and Environmental Engineering, Cornell University, Riley Robb Hall 322, Ithaca, NY, 14853, USA
| | - Minglin Ma
- Department of Biological and Environmental Engineering, Cornell University, Riley Robb Hall 322, Ithaca, NY, 14853, USA
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24
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Li Z, Goh TW, Yam GHF, Thompson BC, Hu H, Setiawan M, Sun W, Riau AK, Tan DT, Khor KA, Mehta JS. A sintered graphene/titania material as a synthetic keratoprosthesis skirt for end-stage corneal disorders. Acta Biomater 2019; 94:585-596. [PMID: 31129362 DOI: 10.1016/j.actbio.2019.05.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 01/21/2023]
Abstract
An artificial cornea or keratoprosthesis requires high mechanical strength, good biocompatibility, and sufficient wear and corrosion resistance to withstand the hostile environment. We report a reduced graphene oxide-reinforced titania-based composite for this application. Graphene oxide nanoparticles (GO) and liquid crystalline graphene oxide (LCGO) were the graphene precursors and mixed with titanium dioxide (TiO2) powder. The composites reinforced with reduced GO or LCGO were produced through spark plasma sintering (SPS). The mechanical properties (Young's modulus and hardness), wear behaviour and corrosion resistance were studied using nanoindentation, anoidic polarization, long-term corrosion assay in artificial tear fluid and tribology assay in corroboration with atomic force microscopy and scanning electron microscopy. Biocompatibility was assessed by human corneal stromal cell attachment, survival and proliferation, and DNA damages. Sintered composites were implanted into rabbit corneas to assess for in vivo stability and host tissue responses. We showed that reduced graphene/TiO2 hybrids were safe and biocompatible. In particular, the 1% reduced LCGO/TiO2 (1rLCGO/TiO2) composite was mechanically strong, chemically stable, and showed better wear and corrosion resistance than pure titania and other combinations of graphene-reinforced titania. Hence the 1rLCGO/ TiO2 bioceramics can be a potential skirt biomaterial for keratoprosthesis to treat end-stage corneal blindness. STATEMENT OF SIGNIFICANCE: The osteo-odonto-keratoprosthesis (OOKP) is an artificial cornea procedure used to restore vision in end-stage corneal diseases, however it is contraindicated in young subjects, patients with advanced imflammatory diseases and posterior segment complications. Hence, there is a need of an improved keratoprosthesisskirt material with high mechanical and chemical stability, wear resistance and tissue integration ability. Our study characterized a reduced graphene oxide-reinforced titania-based biomaterial, which demonstrated strong mechanical strength, wear and corrosion resistance, and was safe and biocompatible to human corneal stromal cells. In vivo implantation to rabbit corneas did not cause any immune and inflammation outcomes. In conclusion, this invention is a potential keratoprosthesis skirt biomaterial to withstand the hostile environment in treating end-stage corneal blindness.
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25
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Sun SY, Yeo WC, Tay ABG, Tan DTH, Tan DBP. Canine and Premolar Root Dimensions in Chinese. A Reference for Osteoodontokeratoprosthesis Surgery. Asia Pac J Ophthalmol (Phila) 2018; 7:76-83. [PMID: 29508951 DOI: 10.22608/apo.2017515] [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: 11/08/2022] Open
Abstract
PURPOSE Osteoodontokeratoprosthesis (OOKP) surgery is used to restore vision in end-stage corneal disorders, where an autogenous tooth supporting an optical cylinder is implanted through the cornea under a buccal mucosal graft. The ideal tooth for OOKP is a healthy single-rooted permanent tooth with sufficient buccolingual/palatal root diameter to accommodate an optical cylinder. The aim of this study was to determine the buccolingual/palatal diameters of canine and premolar roots in Chinese, for selection of teeth for OOKP surgery. DESIGN This was an anatomical study on root dimensions of extracted intact teeth. METHODS Extracted canine and premolar teeth (excluding maxillary first premolars) were collected and the buccolingual/palatal and mesiodistal diameters of the root at the cervical line and at 2-mm intervals below the cervical line were measured with Vernier calipers. Other measurements included total tooth length, crown buccolingual/palatal diameter, and root length. Mean and minimum buccolingual/palatal root diameters were compiled for each 2-mm interval. RESULTS A total of 415 extracted teeth (198 male, 217 female) were collected and measured. Recorded dimensions of keratoprostheses in 55 previous OOKP surgeries were used to establish acceptable lamina dimensions to ascertain root size adequacy. Premolars in Chinese female patients were undersized in a small minority. Minimal dimensions of teeth were insufficient if at 6 mm root level, the buccolingual/palatal width was less than 5 mm, or the mesiodistal width was less than 3 mm. This was noted in female mandibular first premolars (5.6%), maxillary second premolars (4.5%), and mandibular second premolars (1.5%). CONCLUSIONS Canines have adequate dimensions for OOKP surgery. However, premolars in Chinese females may be undersized in a small minority.
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Affiliation(s)
- Stella Yue Sun
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Woon Chee Yeo
- Department of Orthodontics, National Dental Centre Singapore, Singapore
| | - Andrew Ban Guan Tay
- Department of Oral & Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | | | - Danny Ben Poon Tan
- Department of Oral & Maxillofacial Surgery, National Dental Centre Singapore, Singapore
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Islam MM, Buznyk O, Reddy JC, Pasyechnikova N, Alarcon EI, Hayes S, Lewis P, Fagerholm P, He C, Iakymenko S, Liu W, Meek KM, Sangwan VS, Griffith M. Biomaterials-enabled cornea regeneration in patients at high risk for rejection of donor tissue transplantation. NPJ Regen Med 2018; 3:2. [PMID: 29423280 PMCID: PMC5792605 DOI: 10.1038/s41536-017-0038-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/06/2017] [Accepted: 12/12/2017] [Indexed: 12/13/2022] Open
Abstract
The severe worldwide shortage of donor organs, and severe pathologies placing patients at high risk for rejecting conventional cornea transplantation, have left many corneal blind patients untreated. Following successful pre-clinical evaluation in mini-pigs, we tested a biomaterials-enabled pro-regeneration strategy to restore corneal integrity in an open-label observational study of six patients. Cell-free corneal implants comprising recombinant human collagen and phosphorylcholine were grafted by anterior lamellar keratoplasty into corneas of unilaterally blind patients diagnosed at high-risk for rejecting donor allografts. They were followed-up for a mean of 24 months. Patients with acute disease (ulceration) were relieved of pain and discomfort within 1–2 weeks post-operation. Patients with scarred or ulcerated corneas from severe infection showed better vision improvement, followed by corneas with burns. Corneas with immune or degenerative conditions transplanted for symptom relief only showed no vision improvement overall. However, grafting promoted nerve regeneration as observed by improved touch sensitivity to near normal levels in all patients tested, even for those with little/no sensitivity before treatment. Overall, three out of six patients showed significant vision improvement. Others were sufficiently stabilized to allow follow-on surgery to restore vision. Grafting outcomes in mini-pig corneas were superior to those in human subjects, emphasizing that animal models are only predictive for patients with non-severely pathological corneas; however, for establishing parameters such as stable corneal tissue and nerve regeneration, our pig model is satisfactory. While further testing is merited, we have nevertheless shown that cell-free implants are potentially safe, efficacious options for treating high-risk patients. A biomaterial implant supports the regeneration of severely damaged corneas in patients at high risk for rejecting conventional transplantation. An international team from Canada, China, India, Sweden, Ukraine and United Kingdom used mini-pigs to confirm the safety of implanting cell-free corneas made from recombinant human collagen and a synthetic lipid, before examining the effects of implantation on human vision in seven patients. The implants were well-tolerated and led to significant vision improvement in patients with damaged corneas due to infection. Furthermore, within two weeks of surgery the implants had relieved pain. Over two years, sensitivity to touch improved, suggesting an ability to promote nerve regeneration. This study supports the use of animal models to test biomaterials designed for medical applications and describes a safe and promising option for treating patients that not treatable by conventional corneal transplantation.
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Affiliation(s)
- M Mirazul Islam
- 1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,2Schepens Eye Research Institute and Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA USA
| | - Oleksiy Buznyk
- 1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, Odessa, Ukraine
| | - Jagadesh C Reddy
- 4Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Nataliya Pasyechnikova
- Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, Odessa, Ukraine
| | - Emilio I Alarcon
- 5Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON Canada
| | - Sally Hayes
- 6School of Optometry and Vision Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.,7Cardiff Institute for Tissue Engineering and Repair (CITER), Cardiff University, Cardiff, UK
| | - Philip Lewis
- 6School of Optometry and Vision Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.,7Cardiff Institute for Tissue Engineering and Repair (CITER), Cardiff University, Cardiff, UK
| | - Per Fagerholm
- 1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Chaoliang He
- 8Key Laboratory of Polymer Eco-materials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - Stanislav Iakymenko
- Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, Odessa, Ukraine
| | - Wenguang Liu
- 9School of Materials Science and Engineering, Tianjin University, Tianjin, China
| | - Keith M Meek
- 6School of Optometry and Vision Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.,7Cardiff Institute for Tissue Engineering and Repair (CITER), Cardiff University, Cardiff, UK
| | | | - May Griffith
- 1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,4Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.,10Department of Ophthalmology and Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Canada
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Ang M, Man R, Fenwick E, Lamoureux E, Wilkins M. Impact of type I Boston keratoprosthesis implantation on vision-related quality of life. Br J Ophthalmol 2017; 102:878-881. [DOI: 10.1136/bjophthalmol-2017-310745] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/02/2017] [Accepted: 09/08/2017] [Indexed: 11/04/2022]
Abstract
AimTo determine the impact of type I Boston keratoprosthesis (KPro) implantation on vision-related quality of life (VRQoL).MethodsProspective study in 33 patients (mean age 56±12 years, 67% male) with bilateral corneal blindness, who underwent a KPro implantation at a single tertiary eye hospital (June 2011–July 2015). VRQoL was evaluated using the Impact of Vision Impairment Questionnaire (IVI) at baseline and at 3–6 months postsurgery, after stabilisation of best-corrected visual acuity (BCVA). Rasch analysis was used to transform the IVI responses into interval-level measures comprising the ‘reading’, ‘mobility’ and ‘emotional’ subscales with effect sizes calculated for pre-post VRQoL scores.ResultsMean preoperative BCVA was counting-fingers at 2 feet in the operated eye (20/240 fellow eye). Preoperative VRQoL scores: −2.27, –2.91 and −3.06 logits for the reading, mobility and emotional subscales, respectively. Device retention rate was 90% over the follow-up period (mean 26±12 months). We observed large gains for reading and mobility of 1.92 logits (effect size 0.88), and 2.64 logits (effect size 0.89) respectively, with a moderate gain in the emotional subscale of 2.11 logits (effect size 0.59). These improvements did not vary significantly with BCVA on multivariate analysis (all p>0.05).ConclusionWe observed a differential short-term improvement to VRQoL after KPro implantation with a significant impact on emotional well-being, which may not be fully explained by visual improvement alone. Further studies are required to confirm if these improvements in VRQoL are sustained in the long-term and are generalisable to other populations.
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Li Z, Yam GHF, Thompson BC, Setiawan M, Goh GTW, Tan D, Mehta JS, Khor KA. Optimization of spark plasma sintered titania for potential application as a keratoprosthesis skirt. J Biomed Mater Res A 2017; 105:3502-3513. [PMID: 28869708 DOI: 10.1002/jbm.a.36198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 08/02/2017] [Accepted: 08/30/2017] [Indexed: 11/11/2022]
Abstract
The manufacture of mechanically strong and biocompatible titania (TiO2 ) materials is of vital importance for their application as corneal implant skirts. This study was aimed at optimizing the selection of raw powder and sintering conditions for TiO2 ceramics. TiO2 compacts were synthesized from five raw powders, denoted as Altair, Inframat, Alfa, Materion, and Amperit, respectively, by spark plasma sintering using different sintering parameters. The XRD and Raman results confirmed that the anatase TiO2 phase in the Inframat powder had converted completely to rutile TiO2 phase after sintering at 900°C and above. The nanoindentation results indicated that among the five types of TiO2 samples sintered at 1100°C, the Inframat pellets possessed the highest Young's modulus and hardness. Additionally, when Materion samples were employed to study the effects of SPS parameters, a higher sintering temperature in the range of 1100-1300°C decreased the mechanical properties of sintered pellets probably due to the generation of more structural defects. Culture of human corneal stromal fibroblasts on the sintered sample surfaces showed that comparably high cell viability and proliferation were observed on all TiO2 samples except Amperit compared to positive control. Furthermore, cells cultured on Inframat TiO2 sintered in the temperature range of 900-1300°C exhibited viability and formation of focal adhesion complex similar to those on control, and those prepared at 1100°C had significantly higher cell proliferation indices than control. In conclusion, Inframat TiO2 consolidated at 1100°C by SPS was the best formulation for the preparation of mechanically strong and biocompatible Keratoprosthesis skirt. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 3502-3513, 2017.
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Affiliation(s)
- Zhong Li
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Gary Hin-Fai Yam
- Singapore Eye Research Institute, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Brianna C Thompson
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Melina Setiawan
- Singapore Eye Research Institute, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | | | - Donald Tan
- Singapore Eye Research Institute, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Jodhbir S Mehta
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore.,Singapore Eye Research Institute, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Khiam Aik Khor
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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Wong KH, Kam KW, Chen LJ, Young AL. Corneal blindness and current major treatment concern-graft scarcity. Int J Ophthalmol 2017; 10:1154-1162. [PMID: 28730122 DOI: 10.18240/ijo.2017.07.21] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022] Open
Abstract
According to World Health Organization, the global prevalence of blindness in 2010 was 39 million people, among which 4% were due to corneal opacities. Often, the sole resort for visual restoration of patients with damaged corneas is corneal transplantation. However, despite rapid developments of surgical techniques, instrumentations and immunosuppressive agents, corneal blindness remains a prevalent global health issue. This is largely due to the scarcity of good quality corneal grafts. In this review, the causes of corneal blindness, its major treatment options, and the major contributory factors of corneal graft scarcity with potential solutions are discussed.
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Affiliation(s)
- Kah Hie Wong
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
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Abstract
Purpose To evaluate the use of cartilage as a potential graft material toward osteo-odontal tissue replacement in keratoprosthesis surgery. Methods We describe a modification of the osteo-odonto-keratoprosthesis surgery that involves the use of autologous auricular conchal cartilage graft (ACCG). In stage 1a, a full-thickness cheek mucosa graft was performed over the ocular surface. In stage 1b, ACCG was harvested via a retroauricular approach. An optical polymethyl-methacrylate cylinder was embedded into a double-layered fragment of cartilage and secured by cyanoacrylate glue. The graft is then placed in a infraorbital pocket. Stage 2, performed after 3 months, involved retrieval of the complex and implantation after reflection of the mucosal flap, corneal trephination, iris and lens removal and anterior vitrectomy. Results We report two cases of chondro-keratoprosthesis (CKPRO) who underwent surgery with up to 15 months of follow-up. Preoperatively, vision was limited to light perception (LP) in both cases. On patient 1, CKPRO was performed in the right eye and the postoperative visual acuity stay limited to LP related to preoperative retinal lesions. On patient 2, CKPRO was performed in the left eye and the vision was improved to 20/100 J6. No postoperative complications such as extrusion, epithelial downgrowth, retrocorneal membrane or endophtalmia were observed. Conclusions ACCG could be an interesting alternative to replace osteo-odontal graft in keratoprosthesis surgery. However, further comprehensive studies with larger sample size and longer follow-up are required. However longer follow-up and a higher number of patient are required to report postoperative complications incidence, survival and functional outcomes.
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31
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Moussa S, Reitsamer H, Ruckhofer J, Grabner G. The Ocular Surface and How It Can Influence the Outcomes of Keratoprosthesis. CURRENT OPHTHALMOLOGY REPORTS 2016; 4:220-225. [PMID: 28936371 PMCID: PMC5566490 DOI: 10.1007/s40135-016-0116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Severe ocular diseases may result in partial or complete limbal cell deficiency. Besides conservative options, treatment options include conjunctival replacement procedures and limbal autografting. Limbal allografts are an option in patients with bilateral limbal cell deficiency. In many of these cases, a keratoprosthesis (KPro) is the last option to restore functional vision in patients with severe corneal blindness with no other options.
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Affiliation(s)
- Sarah Moussa
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Herbert Reitsamer
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Josef Ruckhofer
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Günther Grabner
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria
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Abstract
The cornea is the transparent front part of the eye that transmits light to the back of the eye to generate vision. Loss of corneal transparency, if irreversible, leads to severe vision loss or blindness. For decades, corneal transplantation using human donor corneas has been the only option for treating corneal blindness. Despite recent improvement in surgical techniques, donor cornea transplantation remains plagued by risks of suboptimal optical results and visual acuity, immune rejection and eventually graft failure. Furthermore, the demand for suitable donor corneas is increasing faster than the number of donors, leaving thousands of curable patients untreated worldwide. Here, we critically review the state of the art of biomaterials for corneal regeneration. However, the lessons learned from the use of the cornea as a disease model will allow for extension of the biomaterials and techniques for regeneration of more complex organs such as the heart.
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Affiliation(s)
- M Griffith
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada
| | - E I Alarcon
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - I Brunette
- Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada.,Department of Ophthalmology, University of Montreal, Montreal, QC, Canada
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33
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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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35
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Siebelmann S, Steven P, Hos D, Hüttmann G, Lankenau E, Bachmann B, Cursiefen C. Advantages of microscope-integrated intraoperative online optical coherence tomography: usage in Boston keratoprosthesis type I surgery. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:16005. [PMID: 26780223 DOI: 10.1117/1.jbo.21.1.016005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/14/2015] [Indexed: 05/22/2023]
Affiliation(s)
- Sebastian Siebelmann
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, GermanybUniversity of Cologne, Cluster of Excellence: Cellular Stress Responses in Aging-associated Diseases, Joseph-Stelzmann-Straße 26, Cologne 50931, Germany
| | - Philipp Steven
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, GermanybUniversity of Cologne, Cluster of Excellence: Cellular Stress Responses in Aging-associated Diseases, Joseph-Stelzmann-Straße 26, Cologne 50931, Germany
| | - Deniz Hos
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, Germany
| | | | - Eva Lankenau
- OptoMedical Technologies GmbH (OPmedT), Maria-Goeppert-Straße 1, Luebeck 23562, Germany
| | - Björn Bachmann
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, Germany
| | - Claus Cursiefen
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, Germany
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Konstantopoulos A, Tan XW, Goh GTW, Saraswathi P, Chen L, Nyein CL, Zhou L, Beuerman R, Tan DTH, Mehta J. Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis. PLoS One 2015; 10:e0139653. [PMID: 26460791 PMCID: PMC4604170 DOI: 10.1371/journal.pone.0139653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/16/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Artificial cornea transplantation, keratoprosthesis, improves vision for patients at high risk of failure with human cadaveric cornea. However, post-operative infection can cause visual loss and implant extrusion in 3.2-17% of eyes. Long-term vancomycin drops are recommended following keratoprosthesis to prevent bacterial keratitis. Evidence, though, in support of this practice is poor. We investigated whether prophylactic vancomycin drops prevented bacterial keratitis in an animal keratoprosthesis model. METHODOLOGY Twenty-three rabbits were assigned either to a prophylactic group (n = 13) that received vancomycin 1.4% drops 5 times/day from keratoprosthesis implantation to sacrifice, or a non-prophylactic group (n = 10) that received no drops. All rabbits had Staphylococcus aureus inoculation into the cornea at 7-12 days post-implantation and were sacrificed at predetermined time-points. Prophylactic and non-prophylactic groups were compared with slit-lamp photography (SLP), anterior segment optical coherence tomography (AS-OCT), and histology, immunohistochemistry and bacterial quantification of excised corneas. Corneal vancomycin pharmacokinetics were studied in 8 additional rabbits. RESULTS On day 1 post-inoculation, the median SLP score and mean±SEM AS-OCT corneal thickness (CT) were greater in the non-prophylactic than the prophylactic group (11 vs. 1, p = 0.049 and 486.9±61.2 vs. 327.4±37.1 μm, p = 0.029 respectively). On days 2 and 4, SLP scores and CT were not significantly different. Immunohistochemistry showed a greater CD11b+ve/non-CD11b+ve cell ratio in the non-prophylactic group (1.45 vs. 0.71) on day 2. Bacterial counts were not significantly different between the two groups. Corneal vancomycin concentration (2.835±0.383 μg/ml) exceeded minimum inhibitory concentration (MIC) for Staphylococcus aureus only after 16 days of vancomycin drops. Two of 3 rabbits still developed infection despite bacterial inoculation after 16 days of prophylactic drops. CONCLUSIONS Prophylactic vancomycin drops provided short-term benefit, but did not prevent infection. Achieving MIC in the cornea was not sufficient to prevent Staphylococcus aureus keratitis. Patients should continue to be counselled regarding the risk of infection following keratoprosthesis.
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Affiliation(s)
- Aris Konstantopoulos
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
| | | | | | | | - Liyan Chen
- Singapore Eye Research Institute, Singapore
| | | | - Lei Zhou
- Singapore Eye Research Institute, Singapore
| | | | - Donald Tiang Hwee Tan
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
- Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | - Jod Mehta
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
- Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
- Nanyang Technological University, Singapore
- * E-mail:
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Buznyk O, Pasyechnikova N, Islam MM, Iakymenko S, Fagerholm P, Griffith M. Bioengineered Corneas Grafted as Alternatives to Human Donor Corneas in Three High-Risk Patients. Clin Transl Sci 2015; 8:558-62. [PMID: 25996570 PMCID: PMC4676913 DOI: 10.1111/cts.12293] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Corneas with severe pathologies have a high risk of rejection when conventionally grafted with human donor tissues. In this early observational study, we grafted bioengineered corneal implants made from recombinant human collagen and synthetic phosphorylcholine polymer into three patients for whom donor cornea transplantation carried a high risk of transplant failure. These patients suffered from corneal ulcers and recurrent erosions preoperatively. The implants provided relief from pain and discomfort, restored corneal integrity by promoting endogenous regeneration of corneal tissues, and improved vision in two of three patients. Such implants could in the future be alternatives to donor corneas for high-risk patients, and therefore, merits further testing in a clinical trial.
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Affiliation(s)
- Oleksiy Buznyk
- Filatov Institute of Eye Diseases and Tissue Therapy of the, National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
- Integrative Regenerative Medicine Center, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Nataliya Pasyechnikova
- Filatov Institute of Eye Diseases and Tissue Therapy of the, National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - M Mirazul Islam
- Integrative Regenerative Medicine Center, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Neurosciences, Swedish Medical Nanoscience Center, Karolinska Institutet, Stockholm, Sweden
| | - Stanislav Iakymenko
- Filatov Institute of Eye Diseases and Tissue Therapy of the, National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Per Fagerholm
- Integrative Regenerative Medicine Center, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - May Griffith
- Integrative Regenerative Medicine Center, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Neurosciences, Swedish Medical Nanoscience Center, Karolinska Institutet, Stockholm, Sweden
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Wan KHN, Yiu EPF, Young AL. Corneal transplantation: Beyond the horizon. World J Ophthalmol 2015; 5:36-44. [DOI: 10.5318/wjo.v5.i2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/04/2015] [Accepted: 04/02/2015] [Indexed: 02/06/2023] Open
Abstract
Evolving techniques in keratoplasty have undoubtedly led to thinner corneal grafts. These newer iterations of keratoplasty aim to reduce graft rejections, improve visual acuity and visual rehabilitation. Each technique poses its own advantages and disadvantages; the surgeon should select patients suitable for a particular technique while accounting for their surgical competency given the learning curve associated with these newer techniques. Alternatives to corneal transplant may have a role in addressing the shortages of corneal graft, these bioengineered material and medical treatment still need further studies to demonstrate its clinical applicability.
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