Management of high-risk corneal grafts

Coster, Douglas J.; Williams, Keryn A.

doi:10.1038/sj.eye.6700634

Cited by 33 publications

(23 citation statements)

References 43 publications

(23 reference statements)

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“…These results prompted us to propose an alternative to direct anti-VEGF therapies (Bock et al, 2008a) by using GS-101 as a new tool to prevent corneal angiogenesis (C. Cursiefen, F. Bock, F. E. Kruse, V. Borderie, W. F. Schirra, B. Seitz, D. Meller, B. Frueh Epstein, submitted for publication) for patients in need of a therapeutic alternative to corneal grafting (Coster and Williams, 2003;Panda et al, 2007). The use of anti-VEGF therapies, although efficient, may not be devoid of side effects because VEGF has been proposed recently to be important for the maintenance and function of adult retina neuronal cells (Saint-Geniez et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Potent in Vivo Antiangiogenic Effects of GS-101 (5′-TATCCGGAGGGCTCGCCATGCTGCT-3′), an Antisense Oligonucleotide Preventing the Expression of Insulin Receptor Substrate-1

Al-Mahmood

Colin²,

Farhat³

et al. 2009

J Pharmacol Exp Ther

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Section: Discussionmentioning

confidence: 99%

Potent in Vivo Antiangiogenic Effects of GS-101 (5′-TATCCGGAGGGCTCGCCATGCTGCT-3′), an Antisense Oligonucleotide Preventing the Expression of Insulin Receptor Substrate-1

Al-Mahmood

Colin²,

Farhat³

et al. 2009

J Pharmacol Exp Ther

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“…81 For many patients, however, this may prolong the waiting time and delay the surgery. Sometimes these delays can be unacceptable considering the limited benefits from the process, 38 even if the delay could be assessed before surgery by considering the frequency of a given recipient’s HLA antigens within the donor population. 21 Nonetheless, HLA matching in HR patients appears to have a beneficial effect as shown in more recent studies from Europe in which precise modern molecular methods of typing have been used.…”

Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 99%

Management of high-risk corneal transplantation

Zazzo

Kheirkhah

Abud

et al. 2017

Survey of Ophthalmology

123

102

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The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal graft has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates due to a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered. However, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents. Although a number of immunosuppressive agents have been employed for this purpose, the results vary significantly across different studies. This is partly due to the lack of an optimized method for their use as well as the lack of a precise stratification of the degree of risk in each individual patient. New targeted biologic treatments as well as tolerance-inducing methods show promising horizons in the management of high-risk corneal transplantation in near future.

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“…In vascularised corneas the risk of endothelial rejection can be up to 65% based on the degree of vascularity 13. Immunosuppression is known to improve the graft survival in the short term for such cases; however, the associated risks may not be appropriate for every case 14. Moreover, the long-standing prospects with this strategy are unknown.…”

Section: Corneal Transplantation: Limits and Benefitsmentioning

confidence: 99%

A brief review of Boston type-1 and osteo-odonto keratoprostheses

Avadhanam

Liu

2014

Br J Ophthalmol

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Globally there are ≈4.9 million bilaterally corneal blind and 23 million unilaterally corneal blind. Majority of this blindness exists in the developing countries, where resources for corneal banking and transplant surgery are less than adequate. Survival of corneal grafts gradually declines over the long term. Corneal transplantation has poor prognosis in vascularised corneal beds, ocular surface disease and viral keratitis. Keratoprosthesis (KPro) remains as a final option for end-stage ocular surface disease, multiple corneal transplant failures and high-risk corneal grafts. Boston type-1 KPro and osteo-odonto-keratoprosthesis are the two devices proven useful in recent years. Choice of a keratoprosthetic device is patient specific based on the underlying diagnosis, ocular morbidity and patient suitability. KPro surgery demands a high level of clinical and surgical expertise, lifelong commitment and extensive resources. Improvements in techniques and biomaterials may in the future provide retainable KPros that do not need regular follow-up of patients, have low complications but high retention rates and may be produced at a low cost on a mass scale to be available as 'off the shelf' devices. Because KPros have the potential to effectively address the burden of surgically treatable corneal blindness and may also eliminate the problems of corneal transplantation, more research is required to develop KPros as substitutes for corneal transplantation even in low-risk cases. In those countries where corneal blindness is a major liability, we need a two pronged approach: one to develop eye donation, eye banking and corneal transplantation and the second to establish centres for keratoprostheses, which are affordable and technically not challenging, in a population where default on follow-up visits are high. Until the latter is achieved, KPros should be viewed as a temporary means for visual restoration and be offered in national and supraregional specialised centres only.

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Management of high-risk corneal grafts

Cited by 33 publications

References 43 publications

Potent in Vivo Antiangiogenic Effects of GS-101 (5′-TATCCGGAGGGCTCGCCATGCTGCT-3′), an Antisense Oligonucleotide Preventing the Expression of Insulin Receptor Substrate-1

Potent in Vivo Antiangiogenic Effects of GS-101 (5′-TATCCGGAGGGCTCGCCATGCTGCT-3′), an Antisense Oligonucleotide Preventing the Expression of Insulin Receptor Substrate-1

Management of high-risk corneal transplantation

A brief review of Boston type-1 and osteo-odonto keratoprostheses

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