Artificial corneas versus donor corneas for repeat corneal transplants

Akpek, Esen K.; Alkharashi, Majed; Hwang, Frank S.; Ng, Sueko M; Lindsley, Kristina

doi:10.1002/14651858.cd009561.pub2

Cited by 25 publications

(20 citation statements)

References 56 publications

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“… 12 Until alternative methods for keratoplasty like Descemet stripping automated endothelial keratoplasty, 13 Descemet’s membrane endothelial keratoplasty, 14 and artificial corneas become available, PKP could be the only proven mode of management of failed graft. 15 A comparative study is recommended to study the success rates in these different procedures for failed PKP.…”

Section: Discussionmentioning

confidence: 99%

Outcome of repeat penetrating keratoplasty in eyes with failed penetrating keratoplasty

Khairallah

2016

SMJ

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Objectives:To report the outcomes of penetrating keratoplasty (PKP) surgeries in eyes with failed PKP.Methods:This was a retrospective, non-comparative, descriptive case series. Thirty eyes of 30 patients with failed PKP comprised our study group, they were reviewed from January 2007 to December 2012 at the King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia. Data were collected on best corrected visual acuity before and after one week, one month, 3 months, 6 months, one year, and 2 years following PKP. Intraoperative and postoperative complications, changes in intraocular pressure (IOP), additional surgical procedure and other ocular comorbidities were also documented. The visual outcomes at 6 months and one year were associated with risk factors.Results:Before intervention, 18 (60%) eyes had vision <20/400. Vision was 20/20 to 20/60 in 10 (30%) eyes at 6 months, 17 (57%) eyes at 12 months, and 22 (73%) eyes at 24 months. The variation in IOP at different follow up periods was not significant (p=0.2). The presence of other ocular comorbidity was not significantly associated with functional visual outcome (p=0.4). Additional surgical procedure after repeat PKP enabled a regain of excellent vision in 9 (47%) eyes at one year. The numbers for past corneal surgeries were significantly associated with the visual outcome at 6 months.Conclusion:Penetrating keratoplasty to manage failed PKP resulted in reducing visual disabilities.

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Section: Discussionmentioning

confidence: 99%

Outcome of repeat penetrating keratoplasty in eyes with failed penetrating keratoplasty

Khairallah

2016

SMJ

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“…Results with fully synthetic corneas have been poor;[ 5 , 6 ] the AlphaCor artificial cornea had a retention rate of 80% and 62% at 1 and 2 years respectively. [ 5 ] Devices that use a hybrid of synthetic and biological tissue, such as the Boston keratoprosthesis (Kpro), have recently gained in popularity, as they provide visual improvement with a low extrusion rate.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis

et al. 2015

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BackgroundArtificial cornea transplantation, keratoprosthesis, improves vision for patients at high risk of failure with human cadaveric cornea. However, post-operative infection can cause visual loss and implant extrusion in 3.2–17% of eyes. Long-term vancomycin drops are recommended following keratoprosthesis to prevent bacterial keratitis. Evidence, though, in support of this practice is poor. We investigated whether prophylactic vancomycin drops prevented bacterial keratitis in an animal keratoprosthesis model.MethodologyTwenty-three rabbits were assigned either to a prophylactic group (n = 13) that received vancomycin 1.4% drops 5 times/day from keratoprosthesis implantation to sacrifice, or a non-prophylactic group (n = 10) that received no drops. All rabbits had Staphylococcus aureus inoculation into the cornea at 7–12 days post-implantation and were sacrificed at predetermined time-points. Prophylactic and non-prophylactic groups were compared with slit-lamp photography (SLP), anterior segment optical coherence tomography (AS-OCT), and histology, immunohistochemistry and bacterial quantification of excised corneas. Corneal vancomycin pharmacokinetics were studied in 8 additional rabbits.ResultsOn day 1 post-inoculation, the median SLP score and mean±SEM AS-OCT corneal thickness (CT) were greater in the non-prophylactic than the prophylactic group (11 vs. 1, p = 0.049 and 486.9±61.2 vs. 327.4±37.1 μm, p = 0.029 respectively). On days 2 and 4, SLP scores and CT were not significantly different. Immunohistochemistry showed a greater CD11b+ve/non-CD11b+ve cell ratio in the non-prophylactic group (1.45 vs. 0.71) on day 2. Bacterial counts were not significantly different between the two groups. Corneal vancomycin concentration (2.835±0.383 μg/ml) exceeded minimum inhibitory concentration (MIC) for Staphylococcus aureus only after 16 days of vancomycin drops. Two of 3 rabbits still developed infection despite bacterial inoculation after 16 days of prophylactic drops.ConclusionsProphylactic vancomycin drops provided short-term benefit, but did not prevent infection. Achieving MIC in the cornea was not sufficient to prevent Staphylococcus aureus keratitis. Patients should continue to be counselled regarding the risk of infection following keratoprosthesis.

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“…Corneal diseases are estimated to affect between four and eight million individuals, the majority of whom live in developing countries. 2 , 3 The leading causes of corneal dysfunction include trachoma (involving scarring and vascularization of the cornea), ocular trauma, corneal ulceration, and infections, such as those due to herpes simplex virus. 3…”

Section: Introductionmentioning

confidence: 99%

The potential role of bioengineering and three-dimensional printing in curing global corneal blindness

2018

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An insufficiency of accessible allograft tissue for corneal transplantation leaves many impaired by untreated corneal disease. There is promise in the field of regenerative medicine for the development of autologous corneal tissue grafts or collagen-based scaffolds. Another approach is to create a suitable corneal implant that meets the refractive needs of the cornea and is integrated into the surrounding tissue but does not attempt to perfectly mimic the native cornea on a cellular level. Materials that have been investigated for use in the latter concept include natural polymers such as gelatin, semisynthetic polymers like gelatin methacrylate, and synthetic polymers. There are advantages and disadvantages inherent in natural and synthetic polymers: natural polymers are generally more biodegradable and biocompatible, while synthetic polymers typically provide greater control over the characteristics or property adjustment of the materials. Additive manufacturing could aid in the precision production of keratoprostheses and the personalization of implants.

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Artificial corneas versus donor corneas for repeat corneal transplants

Cited by 25 publications

References 56 publications

Outcome of repeat penetrating keratoplasty in eyes with failed penetrating keratoplasty

Outcome of repeat penetrating keratoplasty in eyes with failed penetrating keratoplasty

Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis

The potential role of bioengineering and three-dimensional printing in curing global corneal blindness

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