Boston Keratoprosthesis Type 1 in Chemical Burns

Abstract

The excellent anatomical retention rates and visual outcomes presented in this study support the remarkable capability of B-Kpro type 1 to restore functional VA in eyes with severe chemical injuries. However, strict control of the postoperative complications is necessary for long-term success. In conclusion, the use of a B-Kpro type 1 after severe chemical burn is a viable option in patients otherwise condemned to the high risk of failure associated with conventional corneal grafts.

Nanohydroxyapatite Coating Attenuates Fibrotic and Immune Responses to Promote Keratoprosthesis Biointegration in Advanced Ocular Surface Disorders

“…This study was limited by a small sample size and a relatively short postoperative follow-up period. Although KPro extrusion is a common problem in human patients, mean time to failure tends to be in the order of years, rather than weeks. , Limbal stem cell deficiency, neovascularization, edema, and scarring associated with chemical burns and other severe corneal pathology are thought to contribute to KPro failure, and higher failure rates are observed following KPro for these indications rather than to replace a previous graft. , As short-term rates of extrusion are low in rabbit and man, mechanical and biological markers of extrusion riskassessed in this studymay be the best way to evaluate surface engineering approaches in the preclinical setting. , Although our follow-up period was too short to observe complete KPro extrusion and some test outcomes did not reach statistical significance, even in the total LSCD model, we noticed several clear disparities in the rabbits implanted with noncoated prostheses after 12 weeks: (1) The persistent epithelial defect, indicated by the fluorescein staining, was more severe; (2) tissue apposition and mechanically tested adhesion were lower; (3) fibrosis was substantially more severe; and (4) tear protein secretion in response to stimuli of injury and KPro implantation was significantly greater than in animals that received coated KPros.…”

“…diseases of the cornea with extensive limbal stem cell deficiency and vascularization, as seen following chemical burns. 10,17,18 Surface modification approaches, where microscale or nanoscale regions of biochemically and topographically optimized material are produced, without changing the properties of the implant, have proven promising in the field of biomedical engineering. A common surface modification approach is hydroxyapatite (HAp) coating, which has been applied to various dental, ophthalmological, and orthopedic implants.…”

Fibrin-Plasma Rich in Growth Factors Membrane for the Treatment of a Rabbit Alkali-Burn Lesion

“…Surgical treatment of the ocular burns ranges from the application of several membranes to promote epithelization and to reduce inflammation, scarring and neovascularization, in patients with mild to moderate ocular injuries [ 61 , 62 , 63 ], or the use of membranes as adjuvant therapy, in patients with severe ocular injuries [ 1 , 61 , 64 , 65 , 66 , 67 , 68 , 69 ] to the performance of penetrating keratoplasty [ 70 , 71 ], in patients with extensive stromal scarring, or the use of keratoprosthesis, in patients who have experienced failed previous surgical procedures [ 72 ].…”

Keratolimbal allograft for limbal stem cell deficiency after severe corneal chemical injury: a systematic review

“…In the largest published study of Allo-CLET for chemical injury (19 eyes, with 22 months mean postoperative follow-up), 31.6% of the eyes achieved BCVA ≥20/200 postoperatively 41. In the largest study describing use of the Boston keratoprosthesis type I after chemical injury (42 eyes, mean follow-up 40.2 months), 61.9% achieved a BCVA of ≥20/200 at last postoperative visit 42. These results suggest that KLAL and Boston keratoprosthesis might produce similar results in LSCD after chemical injury, but a systematic review for keratoprosthesis implantation in this patient population would be required before drawing this conclusion.…”