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
Stable tissue integration is important to keratoprosthesis （KPro）. The aim of this study was to evaluate the tissue bonding ability of hydroxyapatite （HAp）-coated titanium KPro. The samples were divided into three...Stable tissue integration is important to keratoprosthesis （KPro）. The aim of this study was to evaluate the tissue bonding ability of hydroxyapatite （HAp）-coated titanium KPro. The samples were divided into three groups： test groups （IBAD group and AD group） and Ti control. The coated samples had a HAp layer created by ion beam assisted deposition （IBAD） or aerosol deposition （AD）. The surface characteristics were analyzed with SEM, AFM, and XRD. The samples were surgically inserted into the muscles of rabbits. Eight weeks after healing, the attachment to the tissue was tested with a universal test device. The three samples exhibited distinctive surface morphology. The force to remove the HAp implants from the muscles was significantly greater than that of Ti group （P〈0.01）, with the AD samples requiring the greatest force （P〈0.01）. After removal, SEM showed that the tissue was firmly attached to the surface of AD samples. Photomicrographs of the peri-implant muscles showed a layer of aligned fibrous tissue without severe inflammation. The AD samples had more fibroblasts. Results indicate that because of enhanced mechanical adhesion of soft tissue to the implants, HAp-coated Ti by AD is a suitable KPro skirt material.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.
文摘Stable tissue integration is important to keratoprosthesis （KPro）. The aim of this study was to evaluate the tissue bonding ability of hydroxyapatite （HAp）-coated titanium KPro. The samples were divided into three groups： test groups （IBAD group and AD group） and Ti control. The coated samples had a HAp layer created by ion beam assisted deposition （IBAD） or aerosol deposition （AD）. The surface characteristics were analyzed with SEM, AFM, and XRD. The samples were surgically inserted into the muscles of rabbits. Eight weeks after healing, the attachment to the tissue was tested with a universal test device. The three samples exhibited distinctive surface morphology. The force to remove the HAp implants from the muscles was significantly greater than that of Ti group （P〈0.01）, with the AD samples requiring the greatest force （P〈0.01）. After removal, SEM showed that the tissue was firmly attached to the surface of AD samples. Photomicrographs of the peri-implant muscles showed a layer of aligned fibrous tissue without severe inflammation. The AD samples had more fibroblasts. Results indicate that because of enhanced mechanical adhesion of soft tissue to the implants, HAp-coated Ti by AD is a suitable KPro skirt material.
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
