Femtosecond-assisted preparation of donor tissue for Boston type 1 keratoprosthesis.
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ABSTRACT:
SUBMITTER: Moshirfar M
PROVIDER: S-EPMC3151563 | biostudies-literature | 2011
REPOSITORIES: biostudies-literature
Publications
Femtosecond-assisted preparation of donor tissue for Boston type 1 keratoprosthesis.
Moshirfar Majid M Neuffer Marcus C MC Kinard Krista K Lependu Monette T MT Sikder Shameema S
Clinical ophthalmology (Auckland, N.Z.) 20110722
We describe a technique for femtosecond laser-assisted preparation of donor tissue for Boston type 1 keratoprosthesis to provide accurate double punching of the donor tissue for optimized alignment in the visual axis. The technique was reproducibly performed in four donor corneas mounted in an artificial anterior chamber. This technique can provide optically centered donor tissue with smooth trephinated edges. ...[more]
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Project description:ObjectiveTo investigate the visual and anatomical outcomes of Boston keratoprosthesis (Kpro) type 1 reimplantation.DesignSubgroup analysis of multicentre prospective cohort study.ParticipantsOf 303 eyes that underwent Kpro implantation between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centres, 13 eyes of 13 patients who underwent reimplantation of Boston Kpro type 1 were compared with 13 eyes of 13 diagnosis-matched patients who underwent initial implantation.MethodsForms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and analyzed. Main outcome measures were Kpro retention and logMAR visual acuity.ResultsAfter a mean follow-up time of 17.1 ± 17.6 months, the retention of both initial and repeat Kpro implantation was 92.3% (12/13 in both groups), and 62% of initial implantation and 58% of repeat implantation eyes achieved visual acuity better than 20/200. Vision worse than 20/200 was often due to glaucoma or posterior segment pathology. Best-recorded logMAR visual acuity was significantly improved postoperatively in both groups (p < 0.001), and there was no statistically significant difference in final logMAR visual acuity between the 2 groups (p = 0.89). Sterile keratolysis (n = 4) and fungal infection (n = 5) were the most common causes of initial Kpro failure in the repeat Kpro group. The single failure in the repeat Kpro implantation group was due to fungal keratitis, and in the control group it was related to Kpro extrusion.ConclusionsRepeat Kpro implantation is a viable option after failed initial Kpro, with visual and anatomical outcomes comparable to those of initial procedures.
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Project description:PURPOSE: Despite demonstrated cost effectiveness, not all corneal disorders are amenable to type I Boston keratoprosthesis (KPro) implantation. This includes patients with autoimmune diseases, such as Stevens-Johnson syndrome/toxic epidermal necrolysis. Type II KPro is implanted through the eyelids in severe dry eye and cicatricial diseases, and its cost effectiveness was sought. PATIENTS AND METHODS: In a retrospective chart review, 29 patients who underwent type II KPro surgery at the Massachusetts Eye and Ear Infirmary between the years 2000 and 2009 were identified. A total of 11 patients had 5-year follow-up data. Average cost effectiveness was determined by cost-utility analysis, comparing type II KPro surgery with no further intervention. RESULTS: Using the current parameters, the cost utility of KPro from third-party insurer (Medicare) perspective was 63,196 $/quality-adjusted life year . CONCLUSION: Efforts to refer those less likely to benefit from traditional corneal transplantation or type I KPro, for type II KPro surgery, may decrease both patient and societal costs.
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Project description:To report the retention rate of the Boston keratoprosthesis type 1 and to identify risk factors for keratoprosthesis loss.Cohort study.A total of 300 eyes of 300 patients who underwent implantation of the Boston keratoprosthesis type I device between January 2003 and July 2008 by 19 surgeons at 18 medical centers.Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site.Keratoprosthesis retention.A total cumulative number of 422 life-years of device implantation are included in this analysis. The average duration of follow-up was 17.1 ± 14.8 months, with a range of 1 week to >6.1 years. Ninety-three percent of the 300 Boston keratoprosthesis implants were retained at their last follow-up, corresponding to a retention time of 396 patient-years or 1.42 years/keratoprosthesis. The probability of retention after 1 year and 2 years was 94% and 89%, respectively. During the study period, 21 (7%) eyes failed to retain the device; the reasons for keratoprosthesis loss include sterile keratolysis (9), fungal infections (8), dense retroprosthetic membranes (3), and bacterial endophthalmitis (1). Multivariate analysis demonstrated 3 independent risk factors for keratoprosthesis loss: autoimmune cause (hazard ratio [HR], 11.94; 95% confidence interval [CI], 3.31-43.11), ocular surface exposure requiring a concomitant tarsorrhaphy (HR, 3.43; 95% CI, 1.05-11.22), and number of prior failed penetrating keratoplasties (HR, 1.64; 95% CI, 1.18-2.28).The Boston keratoprosthesis type 1 seems to be a viable option for eyes that are not candidates for penetrating keratoplasty (PK). Ocular surface disease due to an autoimmune cause demonstrated the lowest retention rate.The author(s) have no proprietary or commercial interest in any materials discussed in this article.
| S-EPMC3674188 | biostudies-other
Project description:PURPOSE: The Boston keratoprosthesis has had variable success rates in the past. However, significant modifications to design and management have recently led to successful outcomes. This study was undertaken to evaluate the outcomes of the Boston type 1 keratoprosthesis at our institution. METHODS: A retrospective chart review was performed of all Boston type 1 keratoprosthesis procedures conducted at a single practice at the New York Eye and Ear Infirmary from December 2006 to August 2010. Outcome measures included visual acuity, retention rates, and complications. RESULTS: In all, 58 eyes of 51 patients who received a Boston type 1 keratoprosthesis were included. The most common indication for the keratoprosthesis was failed penetrating keratoplasty (PK) (81.0%; mean 2.4±1.3 PKs per eye). Glaucoma was the most common comorbidity (75.9%). Pre-operative best corrected visual acuity (BCVA) was <20/400 in 87.9% of eyes. At last follow-up, 43.1% of eyes had a BCVA of 20/200. Retention rate was 87.9% over an average follow-up of 21.5±11.4 months (median 22 months, range 3-47 months). Complications increased with time, with 65.5% of eyes experiencing at least one event by 6 months and 75.9% by 1 year. The most common post-operative complication was retroprosthetic membrane formation (50.0%). CONCLUSIONS: The Boston type 1 keratoprosthesis provides visual recovery for eyes with multiple PK failures or with poor prognosis for primary PK, showing excellent retention rates. However, there is a trend towards a decline in visual acuity with time and the development of late complications, highlighting a need for longer-term studies.
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Project description:PURPOSE:To evaluate outcomes of Boston keratoprosthesis type 1 (K-Pro) surgery in a cohort of high-risk patients at Moorfields Eye Hospital. Our patients were referred to us at the end-point of their ocular disease. METHODS:A retrospective review of all K-Pro surgery performed between March 2011 and July 2015 with a minimum follow-up of 12 months. RESULTS:39 eyes of 38 patients were included. Mean follow-up was 28.4 months (range: 12-56). The main indication for surgery was bullous keratopathy from multiple failed grafts (56%). 26 cases (72.2%) had known posterior segment disease pre-operatively. Mean BCVA for the entire cohort (n = 39) initially improved from HM vision to 1/60 before returning to CF vision by 6 months and was maintained for the duration of follow-up. By final follow-up (n = 39), 46% had improved vision (1 line improvement in 10%; 2 lines or more in 36%) and 31% maintained pre-operative visual acuity. Anterior segment pathology was not an independent variable in visual outcome. However, absence of posterior segment disease was significant and performed best, improving from HM to 6/15 and maintaining that vision in the longer term. There were 13 (33%) cases of progressive glaucomatous optic neuropathy, 10 (26%) retinal detachments, 8 (21%) retroprosthetic membranes, 3 (8%) infective keratitis and 2 (5%) vitritis of which 1 progressed to endophthalmitis. In all, 3 (8%) had NPL vision and 4 (10%) required removal of the K-Pro. CONCLUSIONS:Implantation of the Boston K-Pro can lead to improved vision, with the main limiting factor being posterior segment pathology.
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Project description:ImportanceThe loss of vision following Boston Keratoprosthesis (BKPro) surgery due to glaucoma occurs at a high frequency as diagnosis and management of glaucoma after this procedure pose challenges.ObjectiveTo compare visual outcomes in patients undergoing Boston Keratoprosthesis surgery with and without prior or concurrent glaucoma surgery.Design, setting, and participantsThis is a retrospective, observational cohort study of patients who underwent Boston Type I Keratoprosthesis surgery. 19 eyes of 18 patients who had undergone BKPro and met the inclusion criteria were identified. Twelve eyes received BKPro with prior or concurrent glaucoma surgery (Group 1), and seven eyes were identified undergoing BKPro surgery without prior or concurrent glaucoma surgery (Group 2).Main outcomes and measuresMain outcome included best corrected visual acuity at each follow up.ResultsIn Group 1, mean best corrected visual acuity (BCVA) within a year of BKPro surgery was 20/100 (range 20/40 to Count Fingers (CF); n = 12) and mean BCVA at 1 year from BKPro surgery was 20/115 (range 20/30 to CF; n = 12). 7 out of 12 patients retained or had improved BCVA at 1 year follow up after BKPro implantation, and 5 out of 12 patients had mild BCVA worsening. In Group 2, the mean BCVA within a year of BKPro surgery was 20/140 (ranging from 20/25 to hand motion vision (HM); n = 7) and mean BCVA at 1 year from BKPro surgery was Count Fingers (range 20/60 to Light Perception (LP); n = 6). 4 out of 6 patients lost significant vision at one year after BKPro.Conclusions and relevanceBKPro patients with early glaucoma surgical intervention retained vision significantly better compared to patients with late or no intervention. Our preliminary findings support the recommendation for concurrent or pre-emptive glaucoma surgical intervention in patients undergoing BKPro implantation.
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Project description:IntroductionThe purpose of this study was to describe the results using the Nd:YAG laser to reopen blocked glaucoma tube shunts in three ocular chemical burn patients with Boston keratoprostesis type I (KPro) implantation.MethodsThe medical records of the three patients at Zhongshan Ophthalmic Centre were reviewed.ResultsPatient 1, who had glaucoma secondary to KPro implantation, had undergone Ahmed glaucoma valve (AGV) implantation to control an elevated intraocular pressure (IOP). One day after surgery, the tube was observed to be embedded in the residual lens capsule. The capsule was opened by one 1.5 mJ laser pulse, with a subsequent drop in the IOP. In patient 2, the AGV and KPro had been implanted simultaneously. One month after surgery, the IOP increased to 35 mmHg, estimated by palpation, and a vitreous gel was seen blocking the tube. A Nd:YAG laser pulse was used to open the occluded tube. In patient 3, the tube was blocked by iris tissue; Nd:YAG laser treatment opened the tube.ConclusionsThe cases described here indicate that Nd:YAG laser treatment seems to be a valuable option for opening an occluded AGV tube in patients with KPro implantation. The correct location of the tube tip, visualized through the KPro optic, is essential for laser treatment.
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Project description:PurposeInflammatory cytokines are involved in glaucoma pathogenesis. The purpose is to compare cytokine levels in the tear film of Boston keratoprosthesis (KPro) patients with and without glaucoma, relative to controls, and correlate levels with clinical parameters.MethodsThis cross-sectional study enrolled 58 eyes (58 patients): 41 KPro eyes with glaucoma, 7 KPro eyes without glaucoma, and 10 healthy controls. Twenty-seven cytokines were measured by multiplex bead immunoassay. Intraocular pressure (IOP), cup-to-disk ratio (CDR), retinal nerve fiber layer, visual acuity, topical medications, and angle closure were assessed in all KPro eyes. Cytokine levels between groups were analyzed by nonparametric tests, and correlations with clinical parameters by Spearman's test.ResultsLevels of TNF-ɑ, IL-1β, FGF-basic, and IFN-ɣ were significantly higher in KPro with glaucoma compared to KPro without (P = 0.020; 0.008; 0.043; 0.018, respectively). KPro groups had similar characteristics and topical antibiotic/steroid regimen. Levels of IL-1Ra, IL-15, VEGF, and RANTES were significantly higher in KPro with glaucoma compared to controls (P < 0.001; = 0.034; < 0.001; = 0.001, respectively). IL-1β and IFN-ɣ levels were positively correlated with CDR (r = 0.309, P = 0.039 and r = 0.452, P = 0.006, respectively) and IOP (r = 0.292, P = 0.047 and r = 0.368, P = 0.023, respectively). TNF-α and FGF-basic levels were positively correlated with CDR (r = 0.348, P = 0.022 and r = 0.344, P = 0.021, respectively).ConclusionsTNF-α, IL-1β, FGF-basic, IFN-ɣ are elevated in tears of KPro patients with glaucoma and correlate with CDR and IOP. These results show, for the first time in humans, concordance with documented elevations of TNF-α and IL-1β in the murine KPro model. Ocular surface inflammation may reflect inflammatory processes of KPro glaucoma.
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Project description:Purpose:To report the first successfully treated case of recurrent tube exposure in a patient with the Boston Keratoprosthesis type 1 with a collagen matrix patch graft (Ologen). Observations:A 50 year-old female with a Boston Keratoprosthesis type 1 and a history of Axenfeld-Reiger syndrome presents to our department with recurrent glaucoma drainage device exposure in her left eye. After failed spontaneous closure with topical antibiotics and lubricants, she undergoes tube exposure repair using an Ologen patch graft. Surgery was successful and the patient did not have any recurrence up to last follow-up two years post-operatively. Conclusion:Collagen matrix patch graft seems to be advantageous in treating glaucoma tube exposure in the Boston KPro eye, which is often a more challenging entity to treat. Importance:Collagen matrix patch graft could be considered as a primary patch graft in treating tube exposure in eyes with the Boston KPro.
| S-EPMC6104558 | biostudies-literature