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Purpose: To investigate the impact of Boston Type I Keratoprosthesis (BI-Kpro) implantation on retinal and visual pathway function, respectively, assessed by full-field electroretinography (ERG) and visually evoked potentials (VEPs). Methods : This is a prospective interventional longitudinal study, and patients with BI-Kpro implantation were assessed preoperatively and at 3 and 12 months after surgery. ERG, flash, and pattern-reversal VEPs (15' and 60' checks) along with visual acuity (VA) were performed. Results: A total of 13 patients (24 to 88 years of age) were included. Mean baseline VA (logMAR) improved from 2.30 to 1.04 at 3 months and to 1.00 at 12 months. Flash VEPs were normal in 6 (46%) patients and in 10 (77%) patients at the 12-month follow-up. PVEP was non-detectable in all patients preoperatively for both check sizes. For 15' check size, 6 (46%) patients showed responses after 3 and 12 months except for 1 patient with normal responses at 12 months with the remaining non-detectable. For 60' checks, 11 (85%) patients had responses 3 months after surgery with only 9 (70%) showing responses at 12 months. Abnormal full-field ERGs were found in all patients preoperatively. Amplitude improvement was found in 10 (77%) patients from baseline to 3 months and in 8 (62%) patients from the 3- to the 12-month follow-up. Conclusions: In this small cohort of patients with BI-Kpro implantation, a remarkable improvement on visual function quantitatively assessed by electrophysiological testing was found in the majority of cases. Visual electrophysiological testing can contribute to objectively assess functional outcomes in this population. [ABSTRACT FROM AUTHOR]

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The exceptional adhesive properties of polydopamine (PDA) and its ability to perfectly fix various biomolecules and metal ions are conducive for the development of appropriate modifications of implant surfaces. Over the recent years, several combinations of different substrates and surface modification molecules and/or ions have been tested effectively with PDA. In addition, a number of these combinations were proved to have good biocompatibility and specific functions. Therefore, this article summarizes the latest developments in implant surface modification using PDA, in various fields ranging from orthopedics and dentistry to corneal and cardiovascular implants. In addition to osteogenesis, the antibacterial and anti-inflammatory functions of PDA-coated surfaces are also discussed. These studies suggest that PDA, which has strong adhesive properties and good biocompatibility, has potential for use in the surface modification of a variety of functional implants. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the surgical treatment results for conjunctival limbal autograft (CLAU) and keratolimbal allograft (KLAL) in various types of limbal stem cell deficiency (LSCD) etiologies performed in order to achieve a stable ocular surface prior to KPro implantation. Methods: We analyzed the outcomes of the surgical treatment of 43 eyes of 39 patients with LSCD as an initial treatment preparing patients' ocular surface for KPro implantation. The most common causes were ocular trauma (50.7%), mainly alkali burns (77%); autoimmune causes, mainly ocular cicatricial pemphigoid (OCP; 17.4%); infection (15.9%) including Lyell's syndrome/Stevens–Johnson syndrome (LS/SJS; 16%). In all 17 eyes operated on with CLAU, this procedure was performed once. Similarly, one uncomplicated KLAL procedure in one eye was performed in 10 women and 19 men. In another one woman and three men, KLAL was performed in both eyes. In one man with Lyell's syndrome, the KLAL operation was performed three times in one eye. Follow-up was at least 12 months. Results: Visual acuity (VA) improved in 17 eyes (31%) and remained unchanged in 38 eyes (69%). VA improved from light perception to hand movements in three eyes (16%) from the CLAU group of patients and eight eyes (15%) from the KLAL group; VA improved from hand movements to finger counting in two eyes (12%) post CLAU and two eyes (4%) post KLAL operation. The most common complication of surgical treatment was persistent epithelial defect that was refractory to medical treatment in 32 eyes (58%), 5 eyes post CLAU and 27 post KLAL. Corneal conjunctivalization (19%) and neovascularization (29%) were present on the corneal edge of the graft. Symblephara recurred within 3 months in nine eyes (17.3%) after KLAL, including four eyes that had been chemically burned and five eyes with LS/SJS. Discussion: Pretreatment with CLAU or KLAL procedures in severely damaged ocular surfaces allows the ocular surface to be prepared for safe KPro implantation with sufficient tissue surroundings with less conjunctivalization and deeper conjunctival fornices. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to describe the results using the Nd:YAG laser to reopen blocked glaucoma tube shunts in three ocular chemical burn patients with Boston keratoprostesis type I (KPro) implantation. Methods: The medical records of the three patients at Zhongshan Ophthalmic Centre were reviewed. Results: Patient 1, who had glaucoma secondary to KPro implantation, had undergone Ahmed glaucoma valve (AGV) implantation to control an elevated intraocular pressure (IOP). One day after surgery, the tube was observed to be embedded in the residual lens capsule. The capsule was opened by one 1.5 mJ laser pulse, with a subsequent drop in the IOP. In patient 2, the AGV and KPro had been implanted simultaneously. One month after surgery, the IOP increased to 35 mmHg, estimated by palpation, and a vitreous gel was seen blocking the tube. A Nd:YAG laser pulse was used to open the occluded tube. In patient 3, the tube was blocked by iris tissue; Nd:YAG laser treatment opened the tube. Conclusions: The cases described here indicate that Nd:YAG laser treatment seems to be a valuable option for opening an occluded AGV tube in patients with KPro implantation. The correct location of the tube tip, visualized through the KPro optic, is essential for laser treatment. [ABSTRACT FROM AUTHOR]

Purpose: Artificial cornea is the effective treatment option for corneal blindness. One of the challenges with the artificial cornea is limited, or no tissue integration necessitates reimplantation due to necrosis or corneal melting. We propose here a new formulation approach for core-skirt incorporating graphite in the outer skirt region to improve cell adhesion.Methods: Hydroxyethyl methacrylate (HEMA) and ethylene glycol dimethacrylate were procured from Sigma-Aldrich. Polyhydroxyethyl methacrylate (PHEMA) was synthesized by free radical polymerization of HEMA. PHEMA hydrogel core with graphite incorporated skirt was developed with the help of mould and spacer. Pores were introduced into the skirt by salt leaching technique using sodium chloride as porogen. The porous skirt was improved for its aesthetic appeal of black colour and mechanical strength to sustain intraocular pressure by incorporating graphite. The material properties of the newly developed design were evaluated in terms of wetting behaviour, mechanical strength, water vapour permeability, degradation profile and cell adhesion.Results: The polymerization of HEMA was confirmed by thin layer chromatography and FTIR. Water content of the polymeric film was optimized at 50% where maximum transparency with required refractive index of 1.4 was obtained. The concentration of salt vital for the essential porosity was also optimized using optical microscopy and scanning electron microscopy. Other properties, namely mechanical strength, water vapour transmission rate and degradation behaviour, showed that the developed design is suitable for ocular applications. Furthermore, cell adhesion study confirmed tissue adhesion in the skirt region but absent in the core.Conclusion: The core-skirt design may offer an efficient cornea replacement alternative with enhanced tissue integration in addition to desired mechanical behaviour with a clear and aesthetic vision. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the outcomes of the Boston type 1 keratoprosthesis (Kpro-1) in eyes with failed keratoplasty. A retrospective review was performed of every patient treated with a Kpro-1 at a tertiary eye care center between January 1, 2008 and July 1, 2013. Eyes with a failed keratoplasty originally performed for corneal edema, trauma, or keratoconus were included in the statistical analysis. The main outcome measures were visual outcome, prosthesis retention, and postoperative complications. Twenty-four eyes met the inclusion criteria, including 13 eyes with corneal edema, 8 eyes with trauma, and 3 eyes with keratoconus. After a mean follow-up period of 28.9 months (range 7-63 months), the median best corrected visual acuity (BCVA) was 20/125. The BCVA was ≥20/40 in 4 (16.7 %) eyes, ≥20/70 in 9 (37.5 %) eyes, and ≥20/200 in 14 (58.3 %) eyes. Overall, the postoperative BCVA improved in 17 (70.9 %) eyes, was unchanged in 3 (12.5 %) eyes, and was worse in 4 (16.7 %) eyes. The initial Kpro-1 was retained in 22 (91.7 %) eyes, and was successfully repeated in the other 2 eyes. One or more serious prosthesis- or sight-threatening complications occurred in 8 (33.3 %) eyes. These included 1 case of wound dehiscence leading to prosthesis extrusion, 1 case of fungal keratitis leading to prosthesis extrusion, 4 cases of endophthalmitis, and 5 retinal detachments. The Boston Kpro-1 is associated with an excellent prognosis for prosthesis retention and satisfactory visual improvement in eyes with previous failed keratoplasty. [ABSTRACT FROM AUTHOR]

To report the clinical and microbiological characteristics of infectious endophthalmitis after Boston type I keratoprosthesis (B-K-Pro) implantation. Retrospective analysis of 136 eyes that received a B-K-Pro type 1 between 1999 and 2012 was performed. Five eyes with a diagnosis of exogenous endophthalmitis after B-K-pro type 1 were identified and information about demographic data, indication for K-Pro, post-operative bandage contact lens use, post-operative prophylactic antibiotic use, timing and clinical presentation of endophthalmitis, gram stain and culture results of intraocular fluid and preoperative and post-operative visual acuity were collected. The incidence of endophthalmitis was 3.67 % (5 of 136 eyes) and average time to develop endophthalmitis was 5.62 months (range 2 days to 8 months). Mean patient age was 31.4 years (5 to 65 years). The surgical indications included corneal injury due to chemical burns ( n = 2), multiple failed grafts secondary to microbial keratitis ( n = 2) and congenital glaucoma with congenital herpetic keratitis ( n = 1). Post-Boston K-Pro, the visual acuity ranged from light perception (LP) to 20/50. K-pro was explanted in 4 patients. There was bacterial and fungal growth in two patients each and one vitreous did not grow anything. All the eyes were phthisical at last visit. Infectious endophthalmitis after K-Pro implantation in our study had a higher incidence, early onset and extremely poor visual outcome compared with post-cataract surgery endophthalmitis, as reported in literature. Not only bacterial but also fungal infections are an important etiology for infectious endophthalmitis in these cases. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to describe a new technique and analyse the early outcomes of augmenting the canine tooth using a mandibular bone graft in an attempt to delay or retard the process of laminar resorption following the modified osteo odonto keratoprosthesis (MOOKP) procedure. Design: This was a retrospective case series. Patients and methods: Eyes that underwent the bone augmentation procedure between December 2012 and February 2014 were retrospectively analysed. The procedure, performed by the oromaxillofacial surgeon, involved securing a mandibular bone graft beneath the periosteum on the labial aspect of the canine tooth chosen to be harvested for the MOOKP procedure. This procedure was performed simultaneously with the Stage 1 A of the MOOKP. Three months later, the tooth was harvested and fashioned into the osteo-odonto alveolar lamina similar to the method described in the Rome-Vienna Protocol. Results: The bone augmentation procedure was performed in 11 eyes (five SJS/ six chemical injuries). The mean follow-up after Stage 2 of MOOKP procedure in these eyes was 7.45 months (2 to 20 months). Complications noted were peripheral laminar exposure (three eyes-SJS) and bone graft exposure and necrosis in the mouth (nine-SJS). No evidence of clinical laminar resorption was noted in any of the eyes. Conclusion: Laminar resorption in MOOKP can lead to vision and globe threatening complications due to the consequent cylinder instability and chances of extrusion. Augmenting the bone on the labial aspect of the canine tooth might have a role to play in delaying or preventing laminar resorption. [ABSTRACT FROM AUTHOR]

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To report the clinical and microbiological characteristics of infectious endophthalmitis after Boston type I keratoprosthesis (B-K-Pro) implantation. Retrospective analysis of 45 eyes that received a B-K-Pro type 1 between 2009 and 2012 was performed. Five eyes with a diagnosis of exogenous endophthalmitis after B-K-pro type 1 were identified and information about demographic data, indication for K-Pro, post-operative bandage contact lens use, post-operative prophylactic antibiotic use, timing and clinical presentation of endophthalmitis, gram stain and culture results of intraocular fluid and preoperative and post-operative visual acuity were collected. The incidence of endophthalmitis was 11.1 % (5 of 45 eyes) and average time to develop endophthalmitis was 5.62 months (range 2 days to 8 months). Mean patient age was 31.4 years (5 to 65 years). The surgical indications included corneal injury due to chemical burns ( n = 2), multiple failed grafts secondary to microbial keratitis ( n = 2) and congenital glaucoma with congenital herpetic keratitis ( n = 1). Post-Boston K-Pro, the visual acuity ranged from light perception (LP) to 20/50. K-pro was explanted in 4 patients. There was bacterial and fungal growth in two patients each and one vitreous did not grow anything. All the eyes were phthisical at last visit. Infectious endophthalmitis after K-Pro implantation in our study had a higher incidence, early onset and extremely poor visual outcome compared with post-cataract surgery endophthalmitis, as reported in literature. Not only bacterial but also fungal infections are an important etiology for infectious endophthalmitis in these cases. [ABSTRACT FROM AUTHOR]

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Copyright of Spektrum der Augenheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Spektrum der Augenheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To describe a new technique and analyze the outcome of procedures performed for anatomic and functional rehabilitation in eyes with lamina resorption following the modified osteo-odonto keratoprosthesis (MOOKP) procedure. Design: Retrospective case series. Patients & methods: Eighteen eyes were noted to have lamina resorption of the 85 eyes that underwent the MOOKP surgery over the last 10 years. Further intervention to salvage the globe, and therefore the visual potential, was possible in only 11 eyes, of which two are yet to undergo further intervention. Two patients who had undergone the procedure elsewhere also presented to our centre with evidence of resorption. In all, 11 eyes (nine operated at our centre, two operated elsewhere) were included in this study. Bone morphogenetic protein (BMP) was used alone or along with mandibular cancellous bone within the fibrovascular capsule of the osteo-odonto alveolar lamina, in an effort to prevent further resorption and promote bone generation in areas of resorption in ten eyes. In three of these eyes, there was a continued progression of resorption requiring lamina removal. In these three eyes and another eye with extrusion of the cylinder from the eye, the Lucia Type 2 keratoprosthesis was performed for visual rehabilitation (four eyes). Results: The BMP procedure was performed in ten eyes. Continued resorption with need for further rehabilitative surgery in the form of Lucia Type 2 Kpro was required in three of these eyes. Of the four patients who had the Lucia Type 2 Kpro, visual acuity improved to better than 20/200 in three eyes over a mean follow-up period of 3 months. Of the remaining seven eyes that had the BMP procedure performed, all have remained stable with respect to anatomic integrity of the lamina and globe, with maintenance of or improvement in pre BMP visual acuity over a mean follow-up of 9.2 months. No other complications of the procedure were noted. Conclusion: Resorption of the lamina in MOOKP can be addressed by reinforcing the same with BMP in eyes where the cylinder mobility is not significant, as a means to prolong the longevity of the existing lamina. The Lucia Type 2 Kpro might also have a role to play in the functional rehabilitation of eyes with severe lamina resorption or cylinder extrusion if preparation of a new lamina cannot be performed for various reasons. [ABSTRACT FROM AUTHOR]

Purpose: To describe the outcome of patients with Boston type 1 keratoprosthesis, with regard to anatomical and visual success. Methods: Retrospective case series of patients who underwent Boston type I keratoprosthesis surgery at the Centro de Oftalmología Barraquer in Barcelona and at the University Eye Clinic in Salzburg between May 2006 and December 2011. Sixty-seven eyes were included. Anatomical success, visual acuity, and complication rate were evaluated and correlated with the initial diagnosis. Results: The mean age of patients was 54 years; 62 % were male and 38 % were female. Eleven patients underwent Type I Boston Kpro implantation as a primary procedure, while the other 52 patients had previous graft failure. The most frequent diagnoses were autoimmune diseases (16 eyes), severe chemical or thermal burn (12 eyes), leukoma post-infectious keratitis (seven eyes) and bullous keratopathy (six eyes). The mean follow-up time was 26 months. Retention of the prosthesis was achieved in 95 % at 1 year and 78 % at 4.5 years. Two eyes suffered extrusion of the KPro, six underwent successful exchange of the prosthesis either due to infection, necrosis or extrusion, three KPro's had to be explantated, and two eyes ended up in enucleation due to panophthalmitis. The outcome of the autoimmune cases was similar to the group with 'other diagnoses' and better than those with chemical/thermal burn. The most frequent complication was development of a retroprosthetic membrane in 21 eyes (34 %). Visual acuity (LogMAR) in the chemical/thermal burn group was 2.30 preoperatively, 0.69 at 1 year, 0.52 at 2 years and 0.39 at 3 years; in the autoimmune group visual acuity was 2.3 preoperatively, 0.65 at 1 year, 0.15 at 2 years, and 1.5 at 3 years. Conclusions: Boston type 1 keratoprosthesis is a viable option for patients with repeated graft failure, even for those with challenging diagnoses such as ocular burns and autoimmune syndromes. [ABSTRACT FROM AUTHOR]

The surface of keratoprosthesis (KPro) material was modified with functional proteins to enhance corneal cell growth. Surface modification of poly(methyl methacrylate) (PMMA) substrates resulted in greater relative cornea cells growth. The increased growth rate of fibroblast on PMMA with immobilized functional proteins, fibronectin or epidermal growth factor (EGF), was approx. 39% or 19%, respectively. The modified PMMA surface with fibronectin or EGF also increased the human corneal limbal epithelial cell line (HCLE) growth to a maximum of 27% or 73%, respectively. However, PMMA surfaces with non-covalently adsorbed functional proteins did not significantly promote the growth of fibroblast or HCLE. To achieve the maximum growth of cornea cells, the bulk protein concentrations were in the range of 50 and 100 μg/mL for both proteins. This study found the relationship between specific cell growth and functional protein concentrations. Due to its ability to stimulate cell growth with known protein concentration, the newly designed KPro material with selective immobilized proteins may promote integration between KPro and the host tissue. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

Background: The aim of this work is to characterize a transparent tissue layer partially covering the anterior surface of the type I Boston permanent keratoprosthesis front plate in four patients. Methods: The tissue over the front plate was easily scrolled back as a single transparent layer using a sponge. In two cases, histopathologic analysis was undertaken and immunofluorescent staining with a cytokeratin 3-specific antibody was performed. The relationship of the tissue to the keratoprosthesis device was further characterized using spectral domain high-definition optical coherence tomography (HD-OCT). Results: Histopathologic analysis revealed the tissue to be non-keratinized squamous epithelium. No goblet cells were seen, suggesting the cells were of corneal, and not conjunctival, epithelial origin. Immunofluorescent staining of all cells was positive for cytokeratin 3, a protein strongly associated with corneal epithelium. The tissue was easily discerned by HD-OCT and was of substantial thickness near the external junction between the keratoprosthesis device and the carrier corneal tissue. In three cases, visual acuity was unaffected by the presence or absence of this tissue. In one case, a prominent tissue margin temporarily obscured the visual axis and reduced visual acuity; this resolved with mechanical central debridement and has not recurred. Conclusions: The transparent tissue layer covering the anterior surface of the type I Boston keratoprosthesis front plate was found to represent non-keratinized squamous epithelium, most likely of corneal epithelial origin. This potentially represents a further step in bio-integration of the keratoprosthesis device. In particular, epithelial coverage of the critical junction between the device and the carrier corneal tissue might serve an important barrier function and further reduce the incidence of infection and extrusion of the type I Boston permanent keratoprosthesis. [ABSTRACT FROM AUTHOR]

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Background/Purpose: To compare the rate of retroprosthetic membrane (RPM) formation in Boston Keratoprosthesis (BKPro) with polymethyl methacrylate (PMMA) versus titanium backplates. Design: Retrospective comparative chart review. Methods: Multicenter study population: a total of 78 eyes with keratoprosthesis implants with either PMMA or titanium backplates were included in the study. To be included in the study, all subjects had to have completed a minimum of 6-month follow-up period. Incidence of RPM development at 6-month postoperative period was noted across the study population. PMMA and titanium backplates were then compared by their rate of association with subsequent RPM. Results: Twenty-three out of 55 eyes (41.8%) with PMMA backplates and three out of 23 eyes (13.0%) with titanium backplates had developed an RPM at 6 months after implantation. The titanium backplates were associated with significantly less RPM formation than PMMA backplates ( p = 0.014, Chi-square test). Conclusions: Titanium seems to be associated with less RPM formation than PMMA when used as a material for the BKPro back plate. [ABSTRACT FROM AUTHOR]

PurposeDespite demonstrated cost effectiveness, not all corneal disorders are amenable to type I Boston keratoprosthesis (KPro) implantation. This includes patients with autoimmune diseases, such as Stevens-Johnson syndrome/toxic epidermal necrolysis. Type II KPro is implanted through the eyelids in severe dry eye and cicatricial diseases, and its cost effectiveness was sought.Patients and methodsIn a retrospective chart review, 29 patients who underwent type II KPro surgery at the Massachusetts Eye and Ear Infirmary between the years 2000 and 2009 were identified. A total of 11 patients had 5-year follow-up data. Average cost effectiveness was determined by cost-utility analysis, comparing type II KPro surgery with no further intervention.ResultsUsing the current parameters, the cost utility of KPro from third-party insurer (Medicare) perspective was 63 196 $/quality-adjusted life year.ConclusionEfforts to refer those less likely to benefit from traditional corneal transplantation or type I KPro, for type II KPro surgery, may decrease both patient and societal costs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term clinical and immunohistological outcome of two different non-penetrating keratoprosthesis (KPro) implanted in non-injured rabbit corneas. Materials and methods: Three rabbits underwent implantation of a pHEMA-MMA synthetic cornea in the supradescemetic space, and PMMA synthetic corneas in the supradescemetic space and within the central stroma. Animals were followed for at least 24 months before euthanasia. Periodic evaluation was performed with slit-lamp examination and photography. At the end of the follow-up, histological examination including hematoxylin eosin staining and immunocharacterization against collagen IV, alpha smooth muscle actin (α-SMA) and macrophages was performed. Results: The pHEMA-MMA implant was not extruded, and remained transparent until the end of follow-up. This material did not induce any cell infiltration, corneal scarring or tissue remodeling in the surrounding stroma as shown by immunofluorescence. In contrast, synthetic corneas made of PMMA-induced myofibroblast differentiation, stromal remodeling and macrophage infiltration. This reaction was even more significant in the rabbit with the PMMA implant within the corneal stroma. Conclusion: pHEMA-MMA was clinically biocompatible, and did not induce any inflammatory reaction or scarring when implanted in the supradescemetic space. This material showed more promising biocompatibility results than for PMMA, whether implanted within the central cornea stroma or in the supradescemetic space. [ABSTRACT FROM AUTHOR]

Although endophthalmitis is known to occur frequently in patients with KPros, the management remains a challenge both due to the lack of evidence and the exceptionality of the examination and the therapeutic approach. Three patients implanted with Boston keratoprosthesis for management of ocular cicatricial pemphigoid and severe alkali injury presented with severe late-onset (10–24 months post-operatively), presumed bacterial endophthalmitis. Three-port 25-gauge (g) pars plana vitrectomy was performed in all patients; vitreous samples were acquired and intravitreal vancomycin and cefuroxime were administered. Post-operative outcome was significantly improved in all three cases. Visual acuity improved from perception of light (PL) to 20/400 in the first, PL to counting fingers in the second and PL to 20/400 in the third patient. We present our experience from managing presumed bacterial endophthalmitis with 25 g PPV in patients previously implanted with Boston Kpro, which to the best of our knowledge has not been reported before. Although the number of cases is small to draw accurate conclusions, we have to report that 25 g vitrectomy was performed without significant difficulties and seems to be a useful tool for the management of patients with Kpros requiring vitreoretinal surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a keratoprosthesis, implanted by penetrating keratoplasty, in rabbits. Methods: We implanted our keratoprosthesis (optics and flange portions of polymethylmethacrylate and a polyurethane skirt with micropores) into 14 eyes of 14 rabbits. In four eyes, we evaluated histologically the junction between the keratoprosthesis and host cornea. Long-term keratoprosthesis survival was evaluated in ten eyes by slit-lamp biomicroscopy. Results: The histological study showed good approximation of the keratoprosthesis to the host cornea in the junction area, with overlying superficial corneal stroma on the skirt, keratocyte and collagen fiber ingrowth into the micropores, and partial migration of epithelial cells onto the skirt. However, in the long-term survival study, eight out of ten eyes developed acute suture-related inflammation, considered to be from bacterial infection, requiring enucleation 30 ± 18 weeks after implantation. The remaining two eyes have survived for 70 and 76 weeks. Conclusions: Our keratoprosthesis was well tolerated in the short term. However, further modifications are necessary to avoid corneal infection. [ABSTRACT FROM AUTHOR]

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Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bei penetrierenden Keratoprothesen (KPro) kommt es häufig zu postoperativen Komplikationen die bis zum Verlust des Auges führen können. Um diese Komplikationen zu verringern, wurde eine neue supradescemetsche, nicht penetrierende, Keratoprothese entwickelt. Sie wird durch eine zirkuläre Schürze, die intrastromal verankert wird, befestigt, und liegt auf der Descemet Membran auf. Vier verschiedene biokompatible Polymere wurden in Augen von Hasen (NZW) implantiert. Dazu wurde eine neue Delaminationstechnik und Trepanation entwickelt. In acht Augen wurde je eine KPro (2X PMMA, 2X Hema-NVP, 2X Hema-MMA und 2X Hema-EMA) implantiert. Der postoperative Verlauf war komplikationslos, die Prothesen blieben klar und in situ und erlaubten einen ausgezeichneten Einblick in den Fundus. Die Nachbeobachtungszeit von einem Monat ist jedoch zu kurz um über die Stabilität und den Einsatz dieser KPro für den humanen Gebrauch zu entscheiden. Postoperative complications of transcorneal fixated keratoprosthesis (KPro) are frequent and severe and may lead to the loss of the eye. To avoid these problems, a novel supra-Descemetic, non penetrating mesoplant was developed. It is locked in place by an annular skirt and is placed over Descemet’s membrane. Four different biocompatible polymers were implanted in eyes of New Zealand white rabbits (NZW). A new delamination and trephination technique was developed. In 8 eyes the new KPro (2X PMMA, 2X Hema-NVP, 2X Hema-MMA and 2X Hema-EMA) were implanted. There were no postoperative complications, the KPros stayed clear and in place and allowed an excellent view of the fundus. The follow-up of one month is nevertheless too short to determine stability and possible use of this new KPro in humans. [ABSTRACT FROM AUTHOR]

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