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Global corneal blindness and the boston keratoprosthesis type I.

Global Corneal Blindness and the Boston Keratoprosthesis Type I

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Global corneal blindness and the Boston keratoprosthesis type I

According to the World Health Organization, globally 4.9 million are blind due to corneal pathology. Corneal transplantation is successful and curative of the blindness for a majority of these cases. However, it is less successful in a number of diseases that produce corneal neovascularization, dry ocular surface and recurrent inflammation, or infections. A keratoprosthesis or KPro is the only alternative to restore vision when corneal graft is a doomed failure. Although a number of KPros have been proposed, only two devices, Boston type-1 KPro and osteo-odonto-KPro, have came to the fore. The former is totally synthetic and the latter is semi-biological in constitution. These two KPros have different surgical techniques and indications. Keratoprosthetic surgery is complex and should only be undertaken in specialized centers, where expertise, multidisciplinary teams, and resources are available. In this article, we briefly discuss some of the prominent historical KPros and contemporary devices.

Editorial: global corneal blindness and the Boston keratoprosthesis ..

According to the World Health Organization, globally 4.9 million are blind due to corneal pathology. Corneal transplantation is successful and curative of the blindness for a majority of these cases. However, it is less successful in a number of diseases that produce corneal neovascularization, dry ocular surface and recurrent inflammation, or infections. A keratoprosthesis or KPro is the only alternative to restore vision when corneal graft is a doomed failure. Although a number of KPros have been proposed, only two devices, Boston type-1 KPro and osteo-odonto-KPro, have came to the fore. The former is totally synthetic and the latter is semi-biological in constitution. These two KPros have different surgical techniques and indications. Keratoprosthetic surgery is complex and should only be undertaken in specialized centers, where expertise, multidisciplinary teams, and resources are available. In this article, we briefly discuss some of the prominent historical KPros and contemporary devices.

Global corneal blindness and the Boston ..

et al., Global corneal blindness and the Boston keratoprosthesis type I

The goal of the present study was to evaluate the anatomic characteristics of the critical device-donor cornea interface in eyes implanted with the Boston type I keratoprosthesis using two different, recently commercially available high-resolution, spectral-domain AS-OCT imaging instruments. The focus was specifically on the capability of the instruments to identify and further characterize epithelial migration onto the front plate, and physical gaps between the front plate/stem (specifically, the posterior surface of the front plate) and the adjacent carrier donor corneal tissue.

Two recent case reports have described epithelial tissue, instead of stopping at the edge of the front plate, extending over the edge of the front plate and for a variable distance onto the anterior surface of the front plate in eyes implanted with more recent models of the Boston type I keratoprosthesis., The tissue was confirmed to be epithelium by light microscopic and immunohistochemical analysis. This epithelium, by spanning the junction between the front plate/stem of the keratoprosthesis and the carrier donor corneal tissue, presumably confers a beneficial effect by constituting a barrier to micro-organisms and proteolytic enzymes.

corneal blindness and the boston keratoprosthesis type I

Ament JD Todani A Pineda R II Global corneal blindness and the Boston keratoprosthesis type I

Two studies have examined the utility of AS-OCT in providing information in regard to an implanted Boston type I keratoprosthesis and its relationship to the eye., In these studies, the AC Cornea OCT prototype (OTI, Quebec, Canada) was utilized. The stability of the keratoprosthesis-donor cornea interface was specifically examined by Garcia et al. Physical gaps between the posterior surface of the front plate and the carrier donor corneal tissue were visualized, albeit not examined in a quantitative fashion. No change in the keratoprosthesis-donor cornea interface (ie, no increased gaping or fluid escape) was noted with dynamic AS-OCT imaging in all patients when pressure was placed on the eye with a cotton-tip applicator.

To the best of our knowledge, this current report is the first to utilize commercially available high-resolution, spectral-domain AS-OCT imaging instruments for visualization of an implanted Boston type I keratoprosthesis. Both the Zeiss Cirrus HD-OCT and the Heidelberg Spectralis Anterior Segment Module offered detailed information in regard to the device-donor cornea interface, with both instruments allowing for imaging of epithelial migration onto the anterior surface of the front plate, as well as physical gaps between the front plate/stem and the carrier donor corneal tissue. Further quantitative information in regard to these findings could be obtained utilizing the caliper function on the Cirrus HD-OCT. The Spectralis Anterior Segment Module also has potential caliper functionality; however, this was not available on the instrument used in this study.

Advice on the use of Boston Keratoprosthesis Type I for treating corneal blindness to ..
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  • a major cause of global corneal blindness

    asiaone

  • Boston Keratoprosthesis (KPro) - EyeWiki

    À Venda Hoje. Ingressos se esgotando. Não perca. Preços vão subir.

  • Results from the Multicenter Boston Type 1 Keratoprosthesis ..

    Am J Ophthalmol

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The Boston keratoprosthesis 2014: a step in the …

This study indicates that high-resolution, spectral-domain AS-OCT offers detailed information in regard to the critical device-donor cornea interface that complements and expands the information that can be obtained by slit-lamp examination. Many of these patients require lifelong interventions such as prophylactic topical antibiotics and the wearing of a bandage contact lens in order to keep complications such as infection, desiccation, and melting around the stem at bay., The risk of many of these complications is linked to the integrity of the device-donor cornea interface. By providing information in regard to the degree of integration of the device, ie, extension of epithelium over the edge of the front and lack of physical gaps, these commercially available AS-OCT imaging modalities may play a role in determining optimal clinical management of patients with a Boston type I keratoprosthesis.

28/01/2015 · SpringerLink

All 18 eyes underwent implantation with the Boston type I keratoprosthesis between 2007 and 2012. AS-OCT imaging was obtained at a single point between one month and 5 years after implantation. The mean single time point of acquisition was 29 months after implantation. The most frequent indication for keratoprosthesis placement was previous failed corneal transplantation initially performed secondary to pseudophakic bullous keratopathy (five of 18 eyes) or trauma (three of 18 eyes). Seventeen of the 18 eyes had a keratoprosthesis designed for aphakia placed (94%); only one had a pseudophakic design. Seventeen of the 18 eyes underwent implantation with a keratoprosthesis with a polymethyl methacrylate backplate and only one with a titanium back plate. Eleven of the 18 eyes had a Kontur™ bandage contact lens (Kontur Kontact Lens Co, Inc, Hercules, CA) in place at the time of AS-OCT imaging; in these patients, the bandage contact lens had been in place for at least one month prior to imaging.

October 2015 - Volume 34 - Issue

The patients included in this retrospective case series were derived from the Cornea Service of the Weill Cornell Medical College Department of Ophthalmology. Eighteen eyes implanted with the threadless model of the type I Boston permanent keratoprosthesis were studied. Demographic and clinical data for each patient, including indication for keratoprosthesis, were recorded. All eyes were quantitatively evaluated using the Cirrus HD-OCT (Carl Zeiss Meditec Inc, Dublin, CA). A subset (five eyes) was additionally qualitatively imaged using the Spectralis Anterior Segment Module (Heidelberg Engineering, Heidelberg, Germany).

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