Successful corneal solid tissue transplantation,beginning with penetrating keratoplasty(PKP),and evolving to include contemporary lamellar and endothelial keratoplasty,has been a tremendous advancement in the struggle...Successful corneal solid tissue transplantation,beginning with penetrating keratoplasty(PKP),and evolving to include contemporary lamellar and endothelial keratoplasty,has been a tremendous advancement in the struggle to combat corneal blindness.However,there remain patients with high-risk features predictive of transplant failure,for whom donor keratoplasty is not a viable option.Prosthetic corneas have therefore been developed in order to meet the needs of these patients.The Boston type I keratoprosthesis(BKPro)is the most widely used prosthetic cornea in the treatment of corneal blindness.In the years since the BKPro’s introduction,refinement of surgical technique and clinical management as well as improvements in prosthetic design have contributed to promising patient outcomes,particularly in the short term.As such,patients with keratoprosthesis implants continue to grow in number,and the indications for the BKPro have commensurately increased.However,risks of permanently blinding complications after implantation persist over all stages of follow-up.For the foreseeable future,the success of keratoprosthesis(KPro)implantation will continue to depend on refined patient selection,preoperative optimization,and incisive postoperative management.Here we explore indications,surgical technique and postoperative outcomes as well as several core tenants in the management of BKPro patients:limiting glaucomatous progression,controlling inflammation,and optimizing the ocular surface.The exquisite sensitivity of the BKPro-implanted eye to perturbations in any one of these areas showcases the intimate relationship between the prosthetic device and its surrounding environment.展开更多
AIM:To investigate whether hydroxyapatite(HAp)coating can improve keratoprosthesis(KPro)implant biointegration,ultimately to decrease the risk of implantassociated complications.METHODS:The modified titanium imp...AIM:To investigate whether hydroxyapatite(HAp)coating can improve keratoprosthesis(KPro)implant biointegration,ultimately to decrease the risk of implantassociated complications.METHODS:The modified titanium implant was designed and prepared for artificial cornea.The titanium implant was treated with sandblasting and hydroxyapatite coating by acid-base two-step method.Surface was analyzed by scanning electron microscopy(SEM),KPro implants coated with HAp and KPro implant sandblasted were implanted in rabbits.Tissue adhesion to the implant was assessed and compared to an unmodified implant by histopathology(HE),transmission electron microscopy(TEM)and SEM.RESULTS:SEM demonstrated successful deposition of HAp on titanium implant sandblasted(HA/SB-Ti).The hydroxyapatite coatings caused enhancement of keratocyte proliferation compared with unmodified implant surfaces.HAp coating significantly increased adhesion forces.HAp coating of implants reduced the inflammatory response around the KPro implants in vivo.CONCLUSION:HAp-coated surfaces for use in titanium KPro implant greatly enhanced adherence of the titanium KPro implant in the rabbit cornea.展开更多
AIM: To present results of the keratoprosthesis method used at The Filatov Institute of Eye Diseases and Tissue Therapy. ·METHODS: A retrospective case series analysis was used to describe the development of new ...AIM: To present results of the keratoprosthesis method used at The Filatov Institute of Eye Diseases and Tissue Therapy. ·METHODS: A retrospective case series analysis was used to describe the development of new types of keratoprostheses and methods of implantation as well as different ways of leukoma strengthening. ·RESULTS: Keratoprosthesis was performed in 1 060 eyes of 1 040 patients with leukomas of different etiology: burns, 725 eyes (68.4% ); trauma, 120 eyes (11.3% ); keratitis and ocular pemphigoid, 108 eyes (10.2% ); and bullous keratopathy, 107 eyes (10.1% ). Visual acuity before keratoprosthesis consisted of light perception in 962 eyes (92% ), and 98 eyes (8% ) had minimal visual acuity (1/200-1/50). Both eyes were blind (visual acuity less than 1/200) in 955 patients (91.8% ). The period of blindness varied from 1 to 52 years. As a result of keratoprosthesis, visual acuity of ≥1/200 was restored in 1 023 of 1 060 eyes (96.5%). Visual acuity of 20/200-20/20 was achieved in 716 eyes (67.5%). At the last follow-up visit visual acuity of ≥1/200 was preserved in 806 eyes (76%), visual acuity of 20/200-20/20 was measured in 583 of 1 060 eyes (55%) and good keratoprosthesis fixation in the cornea was achieved in 986 of 1 060 eyes (93%). The minimal follow-up was 12 months (range, 12 months to 37 years, median 5 years). · CONCLUSION: Our techniques of keratoprosthesis effectively restore vision in patients with leukomas that cannot be treated by optical corneal grafting.展开更多
AIM: To present the results of implantation of Iakymenko keratoprosthesis in five patients with vascularized corneal leukoma caused by severe ocular injury. METHODS: Iakymenko keratoprosthesis was implanted into 5 eye...AIM: To present the results of implantation of Iakymenko keratoprosthesis in five patients with vascularized corneal leukoma caused by severe ocular injury. METHODS: Iakymenko keratoprosthesis was implanted into 5 eyes of 5 patients: 4 patients were suffered from chemical burns and 1 patient from explosive injury. The preoperative visual acuity ranged from light perception to hand motion. The implantation surgery was composed of two-stage procedures. The follow-up period was from 9 months to 11 years. The outcome measures were visual acuity, retention, and complications of the keratoprosthesis. RESULTS: Vision improvements were achieved in most patients. All keratoprosthesis were retained within the follow-up period. Corneal melting occurred in one patient and fibrous closure in another patient, both of which were successfully treated. Retinal detachment occurred in one patient after surgery. CONCLUSION: Iakymenko keratoprosthesis seems to be a promising alternative for the patients with severe corneal injury, but further investigation is needed to evaluate the role of Iakymenko keratoprosthesis.展开更多
·AIM:To report a successful osteo-odonto keratoprosthesis(OOKP) procedure in a case of end stage of corneal blindness due to Stevens-Johnson syndrome (SJS).·METHODS:An interventional case report.·RESULT...·AIM:To report a successful osteo-odonto keratoprosthesis(OOKP) procedure in a case of end stage of corneal blindness due to Stevens-Johnson syndrome (SJS).·METHODS:An interventional case report.·RESULTS:We describe a 35-year-old Indian woman,a known case of SJS with bilateral dry eyes and corneal blindness (failed corneal graft with vascularised total corneal opacity in the right eye and non-healing corneal ulcer in the left eye).Vision was hand movement only in both eyes.The corneal ulcer healed with medical treatment resulting in vascularised total corneal opacity with no improvement in vision.OOKP was performed in the right eye and the vision was improved from hand movement to 6/6.The same vision was maintained in the right eye at the last follow-up 5 years after surgery.·CONCLUSION:OOKP provides good visual rehabilitation with long-term anatomically stable prosthesis in patients with end-stage of ocular surface disorders and corneal blindness secondary to SJS.·展开更多
AIM:To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis(TKP)in patients with severe corneal opacifications.METHODS:Three patients with simultaneous corneal...AIM:To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis(TKP)in patients with severe corneal opacifications.METHODS:Three patients with simultaneous corneal and vitreoretinal pathology were treated with a soft contact lens that was used as a TKP to facilitate vitreoretinal surgery.The soft contact lens was fixated with sutures onto the globe so that no leakage was possible.RESULTS:Vitreoretinal surgery with excellent fundus view was possible in all cases.The soft contact lens allowed safe central and peripheral vitrectomy.Surgery was successful in all cases.CONCLUSION:A soft contact lens properly fixated on the globe can successfully replace a TKP.This surgical procedure has several advantages like one size fits all,low costs,and easy access to the material.展开更多
This study was designed to summarize the key points of surgical cooperation involving penetrating corneal transplantation combined with implantation of keratoprosthesis. Preoperative preparation and intraoperative pro...This study was designed to summarize the key points of surgical cooperation involving penetrating corneal transplantation combined with implantation of keratoprosthesis. Preoperative preparation and intraoperative procedures were fully implemented to ensure cooperation with the physicians,.to observe the the severity of the disease, and to guarantee the success of the surgery.展开更多
Background:To determine patient-reported vision-related quality of life(VR-QoL)following Boston type I keratoprosthesis(BI-KPro)surgery and its association with postoperative best-corrected visual acuity(BCVA).Methods...Background:To determine patient-reported vision-related quality of life(VR-QoL)following Boston type I keratoprosthesis(BI-KPro)surgery and its association with postoperative best-corrected visual acuity(BCVA).Methods:Descriptive cross-sectional study.Consecutive consenting patients with BI-KPro were included.The French National Eye Institute Visual Function Questionnaire-25 administered at 51±18 months postoperatively measured VR-QoL.Clinical charts were reviewed for demographics,indications for BI-KPro,baseline and postoperative(at time of interview)BCVA.For patients operated unilaterally,stratification of VR-QoL scores based on BCVA in the non-operated eye was performed.Multivariate linear regression was carried out,using VR-QoL scores as dependent variables,and demographics and postoperative BCVA as covariates.For patients operated bilaterally,Spearman correlation between VR-QoL scores and BCVA was performed.P<0.05 indicated statistical significance.Results:Sixty-four patients,aged 59±14 years,52%male,with a follow-up of 54±19 months,were included.Postoperative BCVA increased from baseline in all operated eyes(P=0.000).In patients with unilateral BI-KPro(n=52),the VR-QoL overall score was 70.7±25.1.Scores on all questionnaire subscales were greater when BCVA in the non-operated eye was>20/200 compared to 20/200(P=0.000).BCVA in the non-operated eye was positively associated with all subscales(P<0.01)independently of age,sex,follow-up duration and postoperative BCVA in the operated eye.In patients with bilateral BI-KPro(n=12)the VR-QoL overall score was 63.0±18.7.BCVA in the best eye positively correlated with Near/Distance activities,and social functioning subscales(P<0.05).There was no significant difference between VR-QoL scores of patients operated unilaterally vs.bilaterally.Conclusions:We describe VR-QoL more than 4 years after BI-KPro surgery.Compared to data at 1 year previously reported,our results suggest that,as vision progressively deteriorates in the operated eye,patients increasingly rely on their non-operated eye.VR-QoL after bilateral BI-KPro is assessed for the first time,and appears comparable to that after unilateral surgery.Larger,prospective,long-term studies,with assessment at baseline,are warranted.展开更多
文摘Successful corneal solid tissue transplantation,beginning with penetrating keratoplasty(PKP),and evolving to include contemporary lamellar and endothelial keratoplasty,has been a tremendous advancement in the struggle to combat corneal blindness.However,there remain patients with high-risk features predictive of transplant failure,for whom donor keratoplasty is not a viable option.Prosthetic corneas have therefore been developed in order to meet the needs of these patients.The Boston type I keratoprosthesis(BKPro)is the most widely used prosthetic cornea in the treatment of corneal blindness.In the years since the BKPro’s introduction,refinement of surgical technique and clinical management as well as improvements in prosthetic design have contributed to promising patient outcomes,particularly in the short term.As such,patients with keratoprosthesis implants continue to grow in number,and the indications for the BKPro have commensurately increased.However,risks of permanently blinding complications after implantation persist over all stages of follow-up.For the foreseeable future,the success of keratoprosthesis(KPro)implantation will continue to depend on refined patient selection,preoperative optimization,and incisive postoperative management.Here we explore indications,surgical technique and postoperative outcomes as well as several core tenants in the management of BKPro patients:limiting glaucomatous progression,controlling inflammation,and optimizing the ocular surface.The exquisite sensitivity of the BKPro-implanted eye to perturbations in any one of these areas showcases the intimate relationship between the prosthetic device and its surrounding environment.
基金Supported by National Stem Cell and Translational Medicine Key Project (No.2017YFA0103204)the National Natural Science Foundation Project (No.81670830)+2 种基金the Capital Clinical Key Project (No. Z161100000516012)the Military Logistics Technology Project (No.CWS13C057)the PLA General Hospital Transformation Medicine Project (No.2016TM-025)
文摘AIM:To investigate whether hydroxyapatite(HAp)coating can improve keratoprosthesis(KPro)implant biointegration,ultimately to decrease the risk of implantassociated complications.METHODS:The modified titanium implant was designed and prepared for artificial cornea.The titanium implant was treated with sandblasting and hydroxyapatite coating by acid-base two-step method.Surface was analyzed by scanning electron microscopy(SEM),KPro implants coated with HAp and KPro implant sandblasted were implanted in rabbits.Tissue adhesion to the implant was assessed and compared to an unmodified implant by histopathology(HE),transmission electron microscopy(TEM)and SEM.RESULTS:SEM demonstrated successful deposition of HAp on titanium implant sandblasted(HA/SB-Ti).The hydroxyapatite coatings caused enhancement of keratocyte proliferation compared with unmodified implant surfaces.HAp coating significantly increased adhesion forces.HAp coating of implants reduced the inflammatory response around the KPro implants in vivo.CONCLUSION:HAp-coated surfaces for use in titanium KPro implant greatly enhanced adherence of the titanium KPro implant in the rabbit cornea.
文摘AIM: To present results of the keratoprosthesis method used at The Filatov Institute of Eye Diseases and Tissue Therapy. ·METHODS: A retrospective case series analysis was used to describe the development of new types of keratoprostheses and methods of implantation as well as different ways of leukoma strengthening. ·RESULTS: Keratoprosthesis was performed in 1 060 eyes of 1 040 patients with leukomas of different etiology: burns, 725 eyes (68.4% ); trauma, 120 eyes (11.3% ); keratitis and ocular pemphigoid, 108 eyes (10.2% ); and bullous keratopathy, 107 eyes (10.1% ). Visual acuity before keratoprosthesis consisted of light perception in 962 eyes (92% ), and 98 eyes (8% ) had minimal visual acuity (1/200-1/50). Both eyes were blind (visual acuity less than 1/200) in 955 patients (91.8% ). The period of blindness varied from 1 to 52 years. As a result of keratoprosthesis, visual acuity of ≥1/200 was restored in 1 023 of 1 060 eyes (96.5%). Visual acuity of 20/200-20/20 was achieved in 716 eyes (67.5%). At the last follow-up visit visual acuity of ≥1/200 was preserved in 806 eyes (76%), visual acuity of 20/200-20/20 was measured in 583 of 1 060 eyes (55%) and good keratoprosthesis fixation in the cornea was achieved in 986 of 1 060 eyes (93%). The minimal follow-up was 12 months (range, 12 months to 37 years, median 5 years). · CONCLUSION: Our techniques of keratoprosthesis effectively restore vision in patients with leukomas that cannot be treated by optical corneal grafting.
基金Supported by National Natural Science Foundation of China (No.81000368)Medical Scientific Research Foundation of Guangdong Province, China (B2008091, A2011327)
文摘AIM: To present the results of implantation of Iakymenko keratoprosthesis in five patients with vascularized corneal leukoma caused by severe ocular injury. METHODS: Iakymenko keratoprosthesis was implanted into 5 eyes of 5 patients: 4 patients were suffered from chemical burns and 1 patient from explosive injury. The preoperative visual acuity ranged from light perception to hand motion. The implantation surgery was composed of two-stage procedures. The follow-up period was from 9 months to 11 years. The outcome measures were visual acuity, retention, and complications of the keratoprosthesis. RESULTS: Vision improvements were achieved in most patients. All keratoprosthesis were retained within the follow-up period. Corneal melting occurred in one patient and fibrous closure in another patient, both of which were successfully treated. Retinal detachment occurred in one patient after surgery. CONCLUSION: Iakymenko keratoprosthesis seems to be a promising alternative for the patients with severe corneal injury, but further investigation is needed to evaluate the role of Iakymenko keratoprosthesis.
文摘·AIM:To report a successful osteo-odonto keratoprosthesis(OOKP) procedure in a case of end stage of corneal blindness due to Stevens-Johnson syndrome (SJS).·METHODS:An interventional case report.·RESULTS:We describe a 35-year-old Indian woman,a known case of SJS with bilateral dry eyes and corneal blindness (failed corneal graft with vascularised total corneal opacity in the right eye and non-healing corneal ulcer in the left eye).Vision was hand movement only in both eyes.The corneal ulcer healed with medical treatment resulting in vascularised total corneal opacity with no improvement in vision.OOKP was performed in the right eye and the vision was improved from hand movement to 6/6.The same vision was maintained in the right eye at the last follow-up 5 years after surgery.·CONCLUSION:OOKP provides good visual rehabilitation with long-term anatomically stable prosthesis in patients with end-stage of ocular surface disorders and corneal blindness secondary to SJS.·
文摘AIM:To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis(TKP)in patients with severe corneal opacifications.METHODS:Three patients with simultaneous corneal and vitreoretinal pathology were treated with a soft contact lens that was used as a TKP to facilitate vitreoretinal surgery.The soft contact lens was fixated with sutures onto the globe so that no leakage was possible.RESULTS:Vitreoretinal surgery with excellent fundus view was possible in all cases.The soft contact lens allowed safe central and peripheral vitrectomy.Surgery was successful in all cases.CONCLUSION:A soft contact lens properly fixated on the globe can successfully replace a TKP.This surgical procedure has several advantages like one size fits all,low costs,and easy access to the material.
文摘This study was designed to summarize the key points of surgical cooperation involving penetrating corneal transplantation combined with implantation of keratoprosthesis. Preoperative preparation and intraoperative procedures were fully implemented to ensure cooperation with the physicians,.to observe the the severity of the disease, and to guarantee the success of the surgery.
文摘Background:To determine patient-reported vision-related quality of life(VR-QoL)following Boston type I keratoprosthesis(BI-KPro)surgery and its association with postoperative best-corrected visual acuity(BCVA).Methods:Descriptive cross-sectional study.Consecutive consenting patients with BI-KPro were included.The French National Eye Institute Visual Function Questionnaire-25 administered at 51±18 months postoperatively measured VR-QoL.Clinical charts were reviewed for demographics,indications for BI-KPro,baseline and postoperative(at time of interview)BCVA.For patients operated unilaterally,stratification of VR-QoL scores based on BCVA in the non-operated eye was performed.Multivariate linear regression was carried out,using VR-QoL scores as dependent variables,and demographics and postoperative BCVA as covariates.For patients operated bilaterally,Spearman correlation between VR-QoL scores and BCVA was performed.P<0.05 indicated statistical significance.Results:Sixty-four patients,aged 59±14 years,52%male,with a follow-up of 54±19 months,were included.Postoperative BCVA increased from baseline in all operated eyes(P=0.000).In patients with unilateral BI-KPro(n=52),the VR-QoL overall score was 70.7±25.1.Scores on all questionnaire subscales were greater when BCVA in the non-operated eye was>20/200 compared to 20/200(P=0.000).BCVA in the non-operated eye was positively associated with all subscales(P<0.01)independently of age,sex,follow-up duration and postoperative BCVA in the operated eye.In patients with bilateral BI-KPro(n=12)the VR-QoL overall score was 63.0±18.7.BCVA in the best eye positively correlated with Near/Distance activities,and social functioning subscales(P<0.05).There was no significant difference between VR-QoL scores of patients operated unilaterally vs.bilaterally.Conclusions:We describe VR-QoL more than 4 years after BI-KPro surgery.Compared to data at 1 year previously reported,our results suggest that,as vision progressively deteriorates in the operated eye,patients increasingly rely on their non-operated eye.VR-QoL after bilateral BI-KPro is assessed for the first time,and appears comparable to that after unilateral surgery.Larger,prospective,long-term studies,with assessment at baseline,are warranted.