The Aurolab Keratoprosthesis (KPro) versus the Boston Type I Kpro: 5-year Clinical Outcomes in 134 Cases of Bilateral Corneal Blindness

Basu, Sayan; Serna‐Ojeda, Juan Carlos; Senthil, Sirisha; Pappuru, Rajeev Reddy; Bagga, Bhupesh; Sangwan, Veena

doi:10.1016/j.ajo.2019.03.016

Cited by 28 publications

(26 citation statements)

References 28 publications

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“…Though such cases can be managed with options other than keratoplasty like keratoprosthesis, as per our protocol, keratoprosthesis is not attempted in patients who have an otherwise seeing fellow eye. [ 15 16 ]…”

Section: Discussionmentioning

confidence: 99%

Endophthalmitis with opaque cornea managed with primary endoscopic vitrectomy and secondary keratoplasty: Presentations and outcomes

Dave

Pappuru

Khader

et al. 2020

Indian J Ophthalmol

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Purpose: To describe the outcomes of endophthalmitis with opaque cornea managed with primary endoscopic vitrectomy and secondary keratoplasty. Methods: Retrospective consecutive interventional case series. All cases of endophthalmitis with opaque cornea which underwent endoscopic vitrectomy followed by secondary keratoplasty were analyzed. The study period was from Jan 2015 to March 2019. The outcome measures were resolution of infection, the magnitude of unnecessary keratoplasties avoided and corneal graft survival. The final anatomic and functional outcomes were reported and compared with relevant literature. Results: Seventy-eight eyes of 78 patients underwent endoscopic pars plana vitrectomy for endophthalmitis with the opaque cornea, of these 14 eyes of 14 patients were deemed eligible for further corneal intervention and were included in the study. The mean age at presentation was 42.27 ± 21.6 years (median 36 years). Etiology-wise, eight cases (57.14%) were post-trauma, three cases (21.42%) post-keratoplasty, two cases (14.28%) were endogenous, and one case (7.14%) following corneal dermoid excision and wound melt. Culture positivity was in 5/14 (35.71%). The mean interval between endoscopic vitrectomy and keratoplasty was 5.42 ± 2.69 months (median 3.5 months). The mean follow-up noted was 20.42 ± 11.45 months (median 17.5 months). The infection resolved in 100% of cases. Unnecessary keratoplasties were avoided in 64/78 (82%) cases due to the primary endoscopic intervention. The favorable anatomic outcome was seen in 11/14 (78.57%) of cases and favorable functional outcome in 8/14 (57.14%) cases. Conclusion: Endoscopic vitrectomy allows for early intervention in endophthalmitis with the opaque cornea. This facilitates early settlement of infection, globe preservation, greater graft survival, and lesser repeat posterior segment procedures.

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Section: Discussionmentioning

confidence: 99%

Endophthalmitis with opaque cornea managed with primary endoscopic vitrectomy and secondary keratoplasty: Presentations and outcomes

Dave

Pappuru

Khader

et al. 2020

Indian J Ophthalmol

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“…It was anodised to a brown colour giving a more acceptable appearance to patients. Although efforts are being made towards reducing device manufacturing cost while maintaining ease of implantation, it is important to note that there are many additional costs associated with any corneal procedure, including access to additional clinical resources, and continued postoperative care, and it is ultimately these factors that create a cost-prohibitive option for many patients requiring corneal replacement (70,(73)(74)(75).…”

Section: Costmentioning

confidence: 99%

Artificial Cornea: Past, Current, and Future Directions

et al. 2021

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Corneal diseases are a leading cause of blindness with an estimated 10 million patients diagnosed with bilateral corneal blindness worldwide. Corneal transplantation is highly successful in low-risk patients with corneal blindness but often fails those with high-risk indications such as recurrent or chronic inflammatory disorders, history of glaucoma and herpetic infections, and those with neovascularisation of the host bed. Moreover, the need for donor corneas greatly exceeds the supply, especially in disadvantaged countries. Therefore, artificial and bio-mimetic corneas have been investigated for patients with indications that result in keratoplasty failure. Two long-lasting keratoprostheses with different indications, the Boston type-1 keratoprostheses and osteo-odonto-keratoprostheses have been adapted to minimise complications that have arisen over time. However, both utilise either autologous tissue or an allograft cornea to increase biointegration. To step away from the need for donor material, synthetic keratoprostheses with soft skirts have been introduced to increase biointegration between the device and native tissue. The AlphaCor™, a synthetic polymer (PHEMA) hydrogel, addressed certain complications of the previous versions of keratoprostheses but resulted in stromal melting and optic deposition. Efforts are being made towards creating synthetic keratoprostheses that emulate native corneas by the inclusion of biomolecules that support enhanced biointegration of the implant while reducing stromal melting and optic deposition. The field continues to shift towards more advanced bioengineering approaches to form replacement corneas. Certain biomolecules such as collagen are being investigated to create corneal substitutes, which can be used as the basis for bio-inks in 3D corneal bioprinting. Alternatively, decellularised corneas from mammalian sources have shown potential in replicating both the corneal composition and fibril architecture. This review will discuss the limitations of keratoplasty, milestones in the history of artificial corneal development, advancements in current artificial corneas, and future possibilities in this field.

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“…Although evidence is still relatively limited, outcomes appear comparable to those of the BKPro. 15 In 2019, the FDA approved a new BKPro model: the Lucia keratoprosthesis. This design reduced manufacturing costs and offers a single titanium back plate 7.75 mm in diameter.…”

Section: Design Development: Evolution Of the Boston Kpro Typementioning

confidence: 99%

<p>Boston Type 1 Keratoprosthesis: Updated Perspectives</p>

Nonpassopon¹,

Niparugs²,

Cortina³

2020

OPTH

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The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.

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The Aurolab Keratoprosthesis (KPro) versus the Boston Type I Kpro: 5-year Clinical Outcomes in 134 Cases of Bilateral Corneal Blindness

Cited by 28 publications

References 28 publications

Endophthalmitis with opaque cornea managed with primary endoscopic vitrectomy and secondary keratoplasty: Presentations and outcomes

Endophthalmitis with opaque cornea managed with primary endoscopic vitrectomy and secondary keratoplasty: Presentations and outcomes

Artificial Cornea: Past, Current, and Future Directions

<p>Boston Type 1 Keratoprosthesis: Updated Perspectives</p>

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