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Bahar I, Reitblat O, Livny E, Litvin G. The first-in-human implantation of the CorNeat keratoprosthesis. Eye (Lond) 2023; 37:1331-1335. [PMID: 35650323 PMCID: PMC10169863 DOI: 10.1038/s41433-022-02105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/10/2022] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe the first clinical implantation of the CorNeat™ keratoprosthesis, which utilizes a polymeric scaffold for biointegration within ocular tissue. METHODS The CorNeat keratoprosthesis was implanted in the right eye of a patient with bilateral corneal opacification and neovascularization secondary to multiple failed grafts. The following surgical technique was used: 360 degree peritomy; epithelial scraping and corneal marking; pre-placement of three corneo-scleral sutures through the implant; central trephination using a 7 mm trephine and host cornea removal; keratoprosthesis placement and sutures tightening while fitting the corneal edge into the posterior groove of the CorNeat keratoprosthesis; and repositioning of the conjunctiva over the implant skirt and fixation with sutures and Fibrin sealant. RESULTS Twelve months postoperatively visual acuity improved to 1/16 from hand movement. The keratoprosthesis was properly positioned. Tactile intraocular pressure was assessed as normal. Regional, mostly nasal, conjunctival retraction of 4-5 mm over the nano-fibre skirt was seen throughout follow-up. The anterior chamber was quiet and well-formed. No other postoperative complications were observed. CONCLUSION This initial case may imply a potential breakthrough in the treatment of corneal disease not amenable to standard corneal transplant. Long follow-up and additional implantations are desired to prove the long-term safety and efficacy of this device.
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Affiliation(s)
- Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Olga Reitblat
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Din N, Chan CC, Cohen E, Iovieno A, Dahan A, Rootman DS, Litvin G. Remote Surgeon Virtual Presence: A Novel Telementoring Method for Live Surgical Training. Cornea 2022; 41:385-389. [PMID: 34759203 PMCID: PMC8820774 DOI: 10.1097/ico.0000000000002921] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We describe the first known use of telementoring in corneal surgery and technology combining a 3-dimensional microscope system, 5G live streaming technology, group chat software, and a virtual reality headset for intercontinental surgical supervision. METHODS Three surgeons in Toronto were proctored by a surgeon in Israel in the implantation of a novel keratoprosthesis device (CorNeat KPro; Ra'anana, Israel) into cadaver eyes. In Toronto, the NGENUITY platform (Alcon) transmitted high-definition, 3-dimensional images to the proctor in Israel who viewed the live video through a GOOVIS Virtual Reality headset with subsecond latency. This was made possible by the LiveU technology (Hackensack, NJ), which is a portable device to increase the bandwidth of transmission. The primary outcome was the successful completion of CorNeat KPro implantation. After each procedure, all surgeons completed a Likert scale questionnaire that assessed opinions on telementoring. RESULTS All participants implanted the CorNeat KPro device. There was significant satisfaction reported. A total cumulative score from the questionnaire was 149 of 150 from the operating surgeons, with a score of 135 of 150 by the proctor. All felt that there was excellent AV quality with no lag time and recommended the technology. CONCLUSIONS Telementoring is a promising tool that can traverse large distances for ophthalmic education.
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Affiliation(s)
- Nizar Din
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Clara C. Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; and
| | | | - David S. Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
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Abstract
PURPOSE The purpose of this study was to evaluate surgical feasibility and long-term integration of the CorNeat Keratoprosthesis (KPro), a novel synthetic cornea, in rabbits. METHODS The CorNeat KPro is a synthetic corneal implant designed to treat corneal blindness by using a polymeric scaffold for biointegration, consequently assimilating synthetic optics within ocular tissues. Eight New Zealand White rabbits were implanted unilaterally with the CorNeat KPro and observed for 6 months. Animals were regularly monitored by a certified ophthalmologist using slit-lamp biomicroscopy. One animal developed postoperative endophthalmitis and was removed from the study 7 weeks postsurgery. At termination, eyes were enucleated and evaluated histologically to assess local tissue integration and inflammatory response. RESULTS The surgical procedure was found feasible. The CorNeat KPro integrated into all operated eyes, resulting in a retention rate of 87.5% at the conclusion of the 6-month follow-up period. We observed minimal-to-mild conjunctival and iridial congestion and did not find additional inflammatory indicators, such as anterior chamber fibrin, flare, or cells. The optical element of the device remained clear with zero incidence of retroprosthetic membrane formation. Histopathological evaluation revealed comparable tissue and cellular reaction in all eyes, consisting of the presence of fibroblasts and associated collagen fibrils within the device's skirt component. Some eyes showed a mild foreign body reaction surrounding the skirt. CONCLUSIONS Clinical and histological findings indicate the integration of the implanted device into the surrounding tissue, evident by the retention rate and the diffuse infiltration of fibroblasts with collagen deposition among the device's fibrils. These data hold promise for clinical application in humans.
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Affiliation(s)
| | - Ido Klein
- CorNeat Vision Ltd, Raanana, Israel;
| | - Yoav Litvin
- Independent Scientific Consultant, Bellingham, WA
| | - Guy Klaiman
- Envigo CRS (Israel), Ness Ziona, Israel; and
| | - Abraham Nyska
- Sackler School of Medicine, Consultant in Toxicologic Pathology, Timrat and Tel Aviv University, Israel.
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Litvin G, Ben Eliahu S, Rotenberg M, Marcovich AL, Zadok D, Kleinmann G. Penetration of moxifloxacin through crosslinked corneas. J Cataract Refract Surg 2014; 40:1177-81. [PMID: 24878254 DOI: 10.1016/j.jcrs.2014.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 01/11/2014] [Accepted: 01/20/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the ability of moxifloxacin to penetrate the rabbit eye after corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light irradiation. SETTING Harlan Biotech Israel, Rehovot, Israel. DESIGN Experimental study. METHODS One eye of 10 New Zealand white rabbits had CXL treatment. One month after treatment and 1 hour before an aqueous humor sample was obtained, 1 drop of 5 mg/mL moxifloxacin (Vigamox) was applied to both eyes of each rabbit every 15 minutes for a total of 4 drops. The aqueous humor samples were sent for high-performance liquid chromatography for antibiotic-concentration analysis. The eyes were enucleated and sent for histology analysis. RESULTS Moxifloxacin levels were obtained and analyzed for all 20 eyes. The mean level of moxifloxacin was 2.26 μg/mL ± 0.89 (SD) (range 1.09 to 4.20 μg/mL) in the treated eyes and 2.43 ± 1.17 μg/mL (range 0.89 to 4.72 μg/mL) in the untreated eyes. The difference between the groups was not statistically significant. Of the 10 eye pairs, lower moxifloxacin aqueous humor concentrations were found in 6 treated eyes and 4 untreated eyes. CONCLUSION Penetration of moxifloxacin into the anterior chamber of rabbits was not influenced by previous CXL treatment. FINANCIAL DISCLOSURES No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Gilad Litvin
- From the Ophthalmology Department (Litvin), Meir Medical Center, Kfar Saba, Harlan Biotech Israel (Ben Eliahu), the Ophthalmology Department (Rotenberg, Marcovich, Kleinmann), Kaplan Medical Center, the Weizmann Institute of Science (Marcovich), Rehovot, and the Ophthalmology Department (Zadok), Assaf Harofeh Medical Center, Rishon Lezion, Israel
| | - Shmuel Ben Eliahu
- From the Ophthalmology Department (Litvin), Meir Medical Center, Kfar Saba, Harlan Biotech Israel (Ben Eliahu), the Ophthalmology Department (Rotenberg, Marcovich, Kleinmann), Kaplan Medical Center, the Weizmann Institute of Science (Marcovich), Rehovot, and the Ophthalmology Department (Zadok), Assaf Harofeh Medical Center, Rishon Lezion, Israel
| | - Michael Rotenberg
- From the Ophthalmology Department (Litvin), Meir Medical Center, Kfar Saba, Harlan Biotech Israel (Ben Eliahu), the Ophthalmology Department (Rotenberg, Marcovich, Kleinmann), Kaplan Medical Center, the Weizmann Institute of Science (Marcovich), Rehovot, and the Ophthalmology Department (Zadok), Assaf Harofeh Medical Center, Rishon Lezion, Israel
| | - Arie L Marcovich
- From the Ophthalmology Department (Litvin), Meir Medical Center, Kfar Saba, Harlan Biotech Israel (Ben Eliahu), the Ophthalmology Department (Rotenberg, Marcovich, Kleinmann), Kaplan Medical Center, the Weizmann Institute of Science (Marcovich), Rehovot, and the Ophthalmology Department (Zadok), Assaf Harofeh Medical Center, Rishon Lezion, Israel
| | - David Zadok
- From the Ophthalmology Department (Litvin), Meir Medical Center, Kfar Saba, Harlan Biotech Israel (Ben Eliahu), the Ophthalmology Department (Rotenberg, Marcovich, Kleinmann), Kaplan Medical Center, the Weizmann Institute of Science (Marcovich), Rehovot, and the Ophthalmology Department (Zadok), Assaf Harofeh Medical Center, Rishon Lezion, Israel
| | - Guy Kleinmann
- From the Ophthalmology Department (Litvin), Meir Medical Center, Kfar Saba, Harlan Biotech Israel (Ben Eliahu), the Ophthalmology Department (Rotenberg, Marcovich, Kleinmann), Kaplan Medical Center, the Weizmann Institute of Science (Marcovich), Rehovot, and the Ophthalmology Department (Zadok), Assaf Harofeh Medical Center, Rishon Lezion, Israel.
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