Keratoprosthesis

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Claes H Dohlman - One of the best experts on this subject based on the ideXlab platform.

  • blood levels of tumor necrosis factor alpha and its type 2 receptor are elevated in patients with boston type i Keratoprosthesis
    Current Eye Research, 2019
    Co-Authors: Eleftherios I Paschalis, Claes H Dohlman, James Chodosh, Kathryn Colby, Elise V. Taniguchi, Louis R. Pasquale, Lucy Q. Shen
    Abstract:

    Purpose: Boston Keratoprosthesis (KPro) patients are prone to glaucoma even with well-controlled intraocular pressure (IOP). Recent experimental data have shown that soluble tumor necrosis factor a...

  • Blood Levels of Tumor Necrosis Factor Alpha and Its Type 2 Receptor Are Elevated in Patients with Boston Type I Keratoprosthesis
    2019
    Co-Authors: Eleftherios I Paschalis, Claes H Dohlman, James Chodosh, Kathryn Colby, Elise V. Taniguchi, Louis R. Pasquale, Lucy Q. Shen
    Abstract:

    Purpose: Boston Keratoprosthesis (KPro) patients are prone to glaucoma even with well-controlled intraocular pressure (IOP). Recent experimental data have shown that soluble tumor necrosis factor alpha (TNF-α) after ocular injury may contribute to progressive retinal damage and subsequent glaucoma. This study evaluates the blood plasma levels of soluble TNF-α, TNF receptors 1 (TNFR1) and 2 (TNFR2), and leptin in patients with Boston type I KPro. Methods: Venous blood samples were collected from KPro patients with glaucoma (KPro G, n = 19), KPro patients without glaucoma (KPro NoG, n = 12), primary angle closure glaucoma without KPro (PACG, n = 13), and narrow angles without glaucoma or KPro (NA, n = 21). TNF-α, TNFR1, TNFR2, and leptin levels were quantified using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) was assessed using the Westergren test. Patients with underlying autoimmune conditions or diabetes were excluded from the study. Results: All groups had similar age, body mass index (BMI), IOP, and ESR (p ≥ 0.11). The mean time from KPro surgery to blood draw was 5.3 ± 3.7 years. Compared to NA patients (0.72 ± 0.3 pg/ml), KPro G and KPro NoG patients had higher blood plasma levels of TNF-α (1.18 ± 0.58 pg/ml, p = 0.006; 1.16 ± 0.50 pg/ml, p = 0.04, respectively). Similarly, KPro G patients had higher blood plasma levels of TNFR2 (2768 ± 1368 pg/ml) than NA patients (2020 ± 435 pg/ml, p = 0.048). In multivariate analysis, KPro status remained positively associated with TNF-α levels (β = 0.36; 95% confidence intervals [CI]: 0.14–0.58; p = 0.002) and TNFR2 levels (β = 458.3; 95% CI: 32.8–883.7; p = 0.035) after adjusting for age, gender, BMI, glaucoma status, and ESR. TNFR1 and leptin levels were not significantly different in the study groups. Conclusions: We detected elevated serum levels of TNF-α and TNFR2 in KPro patients. Longitudinal studies are needed to establish TNF-α and TNFR2 as serum biomarkers related to KPro surgery. Abbreviations: BCVA: best corrected visual acuity; BMI: body mass index; CDR: cup-to-disc ratio; EDTA: ethylenediaminetetraacetic acid; ELISA: enzyme-linked immunosorbent assay; ESR: erythrocyte sedimentation rate; HVF: Humphrey visual field; IOP: intraocular pressure; KPro G: Keratoprosthesis with glaucoma; KPro NoG: Keratoprosthesis without glaucoma; KPro: Keratoprosthesis; MD: mean deviation; NA: narrow angle; non-KPro: without Keratoprosthesis; PACG: primary angle closure glaucoma; RNFL: retinal nerve fiber layer; TNF-α: tumor necrosis factor alpha; TNFR1: tumor necrosis factor receptor 1; TNFR2: tumor necrosis factor receptor 2

  • chemical burns of the eye the role of retinal injury and new therapeutic possibilities
    Cornea, 2017
    Co-Authors: Claes H Dohlman, Fabiano Cade, George N. Papaliodis, Caio V Regatieri, Chengxin Zhou, Fengyang Lei, Alja Crnej, Mona Harissidagher, Marieclaude Robert, Dongfeng Chen
    Abstract:

    Purpose To propose a new treatment paradigm for chemical burns to the eye - in the acute and chronic phases. Methods Recent laboratory and clinical data on the biology and treatment of chemical burns are analyzed. Results Corneal blindness from chemical burns can now be successfully treated with a Keratoprosthesis, on immediate and intermediate bases. Long term outcomes, however, are hampered by early retinal damage causing glaucoma. New data suggest that rapid diffusion of inflammatory cytokines posteriorly (TNF-α, etc) can severely damage the ganglion cells. Prompt anti-TNF-α treatment is markedly neuroprotective. Long term profound reduction of the intraocular pressure is also vital. Conclusion A new regimen, in addition to standard treatment, for severe chemical burns is proposed. This involves tumor necrosis factor alpha (TNF-α) inhibition promptly after the accident (primarily for retinal neuroprotection), prophylactic maximal lowering of the intraocular pressure (starting immediately), and Keratoprosthesis implantation in a later quiet state.

  • long term visual outcomes and complications of boston Keratoprosthesis type ii implantation
    Ophthalmology, 2017
    Co-Authors: Ramon Lee, Claes H Dohlman, James Chodosh, Ziad Khoueir, Edem Tsikata, Teresa C Chen
    Abstract:

    Purpose To report the long-term visual outcomes and complications after Boston Keratoprosthesis type II implantation in the largest single-center case series with the longest average follow-up. Design Retrospective review of consecutive clinical case series. Participants Between January 1992 and April 2015 at the Massachusetts Eye and Ear Infirmary, 48 eyes of 44 patients had Keratoprosthesis type II implanted by 2 surgeons (C.H.D. and J.C.). Methods For each eye, data were collected and analyzed on the preoperative characteristics, intraoperative procedures, and postoperative course. Main Outcome Measures Visual acuity outcomes, postoperative complications, and device retention. Results The most common indications for surgery were Stevens–Johnson syndrome in 41.7% (20 of 48 eyes) and mucous membrane pemphigoid in 41.7% (20 of 48 eyes). Mean follow-up duration was 70.2 months (standard deviation, 61.8 months; median, 52 months; range, 6 months to 19.8 years). Almost all patients (95.8%, 46 of 48 eyes) had a preoperative visual acuity of 20/200 or worse. Postoperative visual acuity improved to 20/200 or better in 37.5% (18 of 48 eyes) and to 20/100 or better in 33.3% (16 of 48 eyes) at the last follow-up visit. The most common postoperative complication was retroprosthetic membrane formation in over half (60.4%, 29 of 48 eyes). The most pressing postoperative complication was glaucoma onset or progression in about a third. Preexisting glaucoma was present in 72.9% (35 of 48 eyes). Glaucoma progressed in 27.1% (13 of 48 eyes) and was newly diagnosed in 8.3% (4 of 48 eyes) after surgery. Other postoperative complications were tarsorrhaphy revision in 52.1% (25 of 48 eyes), retinal detachment in 18.8% (9 of 48 eyes), infectious endophthalmitis in 6.3% (3 of 48 eyes), and choroidal detachment or hemorrhage in 8.3% (4 of 48 eyes). Half of eyes retained their initial Keratoprosthesis at the last follow-up (50.0%, 24 of 48 eyes). Conclusions The Boston Keratoprosthesis type II is a viable option to salvage vision in patients with poor prognosis for other corneal procedures. Retroprosthetic membranes, Keratoprosthesis retention, and glaucoma are major challenges in the postoperative period; however, the Keratoprosthesis can still provide improved vision in a select group of patients.

  • visual acuity outcomes of the boston Keratoprosthesis type 1 multicenter study results
    American Journal of Ophthalmology, 2016
    Co-Authors: Christopher J Rudnisky, Anthony J Aldave, Claes H Dohlman, James V. Aquavella, Kimberly C Sippel, Joseph B Ciolino, Michael W Belin, Rong Guo, Sadeer B Hannush, Mark J Mannis
    Abstract:

    Purpose To report logarithm of the minimal angle of resolution (logMAR) visual outcomes of the Boston Keratoprosthesis type 1. Design Prospective cohort study. Methods Preoperative, intraoperative, and postoperative parameters of 300 eyes of 300 patients who underwent implantation of a Boston Keratoprosthesis type 1 device between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centers were collected. Results After an average of 17.1 ± 14.8 months, visual acuity improved significantly ( P P P  = .08), sex ( P  = .959), operative side ( P  = .167), or failure ( P  = .494) and final visual acuity. The median time to achieve 20/200 visual acuity was 1 month (95% confidence interval 1.0–6.0) and it was retained for an average of 47.8 months. Multivariate analysis, controlling for preoperative visual acuity, demonstrated 2 factors associated with final visual outcome: chemical injury was associated with better final vision ( P  = .007), whereas age-related macular degeneration was associated with poorer vision ( P Conclusions The Boston Keratoprosthesis type 1 is an effective device for rehabilitation in advanced ocular surface disease, resulting in a significant improvement in visual acuity. Eyes achieved a mean value of 20/150 (0.89 ± 0.64 logMAR units) after 6 months and this was relatively stable thereafter. The best visual prognosis is observed in chemical injury eyes, whereas the worst prognosis is in aniridia, although the latter has limited visual potential.

Anthony J Aldave - One of the best experts on this subject based on the ideXlab platform.

  • idiopathic vitritis after boston type 1 Keratoprosthesis implantation incidence risk factors and outcomes in a multicentric cohort
    Ocular Immunology and Inflammation, 2020
    Co-Authors: Mona Harissidagher, Jeanpierre Hubschman, Clemence Bonnet, Ismael Chehaibou, Reza Ghaffari, Nicholas Jackson, Cristina Bostan, Anthony J Aldave
    Abstract:

    To determine incidence, risks factors for, and outcomes of idiopathic vitritis (IV) after Boston type 1 Keratoprosthesis (KPro) implantation. Retrospective, consecutive case series. Risk factors we...

  • long term visual outcomes complications and retention of the boston type i Keratoprosthesis
    Cornea, 2018
    Co-Authors: Carolina Aravena, Anthony J Aldave
    Abstract:

    Purpose To report the long-term outcomes of the Boston type I Keratoprosthesis (KPro). Methods Data were collected regarding preoperative characteristics, surgical procedure(s) performed, and postoperative outcomes of patients who underwent KPro implantation from May 1, 2004, to May 1, 2011, and were followed for 5 years after surgery. Results Seventy-four KPro procedures were performed in 58 eyes (55 patients), with more than 1 KPro implanted in 10 eyes. The mean follow-up duration was 82.8 ± 20.5 months (range 57-145 months), and the most common indication for Keratoprosthesis implantation was corneal transplant failure (50%). Preoperative corrected distance visual acuity (CDVA) was ≥20/200 in 5%; between 1 and 8 years after surgery, the percentage of eyes with CDVA ≥20/200 varied between 57% (4 years) and 82% (8 years). Nineteen (25.7%) KPros implanted were removed (retention failure rate 0.047/eye-year), although a KPro was retained at final follow-up in 55 eyes (94.8%). The most common postoperative complication was retroprosthetic membrane formation in 51.7% of eyes. The incidence of each postoperative complication decreased significantly over the first 10 years after surgery. Conclusions The KPro provides significant visual improvement in most eyes, with more than 50% regaining and maintaining 20/200 CDVA each year through 8 years after surgery. The incidence of each postoperative complication decreases significantly over the first 10 years after surgery. Although almost one-quarter of implanted keratoprostheses were removed, over 90% of eyes reaching 5 years of follow-up retain a Keratoprosthesis at final follow-up.

  • visual acuity outcomes of the boston Keratoprosthesis type 1 multicenter study results
    American Journal of Ophthalmology, 2016
    Co-Authors: Christopher J Rudnisky, Anthony J Aldave, Claes H Dohlman, James V. Aquavella, Kimberly C Sippel, Joseph B Ciolino, Michael W Belin, Rong Guo, Sadeer B Hannush, Mark J Mannis
    Abstract:

    Purpose To report logarithm of the minimal angle of resolution (logMAR) visual outcomes of the Boston Keratoprosthesis type 1. Design Prospective cohort study. Methods Preoperative, intraoperative, and postoperative parameters of 300 eyes of 300 patients who underwent implantation of a Boston Keratoprosthesis type 1 device between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centers were collected. Results After an average of 17.1 ± 14.8 months, visual acuity improved significantly ( P P P  = .08), sex ( P  = .959), operative side ( P  = .167), or failure ( P  = .494) and final visual acuity. The median time to achieve 20/200 visual acuity was 1 month (95% confidence interval 1.0–6.0) and it was retained for an average of 47.8 months. Multivariate analysis, controlling for preoperative visual acuity, demonstrated 2 factors associated with final visual outcome: chemical injury was associated with better final vision ( P  = .007), whereas age-related macular degeneration was associated with poorer vision ( P Conclusions The Boston Keratoprosthesis type 1 is an effective device for rehabilitation in advanced ocular surface disease, resulting in a significant improvement in visual acuity. Eyes achieved a mean value of 20/150 (0.89 ± 0.64 logMAR units) after 6 months and this was relatively stable thereafter. The best visual prognosis is observed in chemical injury eyes, whereas the worst prognosis is in aniridia, although the latter has limited visual potential.

  • international outcomes of the boston type i Keratoprosthesis in stevens johnson syndrome
    Cornea, 2015
    Co-Authors: Jamie K Alexander, Samar K Basak, Ma Dominga B Padilla, Anthony J Aldave
    Abstract:

    PURPOSE To determine the factors influencing outcomes of Boston type I Keratoprosthesis implantation in Stevens-Johnson syndrome (SJS) and to compare the results with those of individuals without SJS. METHODS This is a multicenter, retrospective, comparative consecutive case series of patients undergoing Keratoprosthesis implantation in Los Angeles, Kolkata, and Manila. Statistical analysis was performed to identify significant differences in visual acuity, complications, and retention between SJS and non-SJS populations. RESULTS A total of 234 Keratoprosthesis procedures were performed in 209 eyes, including 40 performed in 27 eyes of 26 patients with SJS. Procedures in patients with SJS were more frequently performed as repeat keratoprostheses (33% vs. 8%, P < 0.001) but less frequently in eyes with glaucoma (26% vs. 71%, P < 0.001) or multiple previous keratoplasties (15% vs. 59%, P < 0.001). A significantly greater percentage of individuals with SJS had a corrected distance visual acuity ≥20/200 12 months after surgery compared with individuals without SJS (100% vs. 67%, P = 0.002). Several postoperative complications were more common in SJS, including corneal stromal necrosis (59% vs. 8%, P < 0.001), corneal infiltrates (30% vs. 10%, P = 0.009), and persistent corneal epithelial defects (59% vs. 24% P < 0.001), which led to a higher retention failure rate (0.306/eye-year vs. 0.068/eye-year, P < 0.001) and secondary surgical procedures. However, after repeat implantation, eyes with SJS were no less likely to ultimately retain a Keratoprosthesis (82% vs. 89%, P = 0.34). CONCLUSIONS The Boston type I Keratoprosthesis is an effective means to restore vision in individuals with SJS. Although retention failure and several postoperative complications are more common in SJS, sight-threatening complications such as endophthalmitis and retinal detachment are not.

  • ocular surface fornix and eyelid rehabilitation in boston type i Keratoprosthesis patients with mucous membrane disease
    Ophthalmic Plastic and Reconstructive Surgery, 2015
    Co-Authors: Daniel B Rootman, Anthony J Aldave, Michelle J Kim, Raymond S Douglas, Catherine J Hwang, Robert J Goldberg
    Abstract:

    Purpose To understand the efficacy of various approaches for ocular surface reconstruction in eyes with implanted Boston Type I Keratoprosthesis. Methods All eyes implanted with a Boston Type I Keratoprosthesis over a 9-year period by a single surgeon were reviewed. Any case in which mucosal rehabilitation was performed was included in the study sample. The type, number, approach, and outcome for all eyelid and ocular surface procedures were assessed. Results A total of 22 mucosal surface surgeries were performed before, concurrent with, and after implantation of 11 keratoprostheses and 1 penetrating keratoplasty (after Keratoprosthesis removal) in 9 eyes of 9 patients. Most of the ocular surface reconstructive surgeries (81.8%; 18/22) were performed at the time of or following Keratoprosthesis implantation, with the most common indication being corneal stromal necrosis (44.4%; 8/18). Free grafting and simple advancement resulted in graft retraction for each case, and pedicle or bucket handle flaps resulted in a stable vascularized graft for half of the cases. Graft retraction occurred in 6 of the 9 eyes in this study, including in all 5 eyes of patients with Stevens Johnsons syndrome (SJS). Conclusions Free grafting and simple advancement flaps do not appear to be effective for rehabilitation in these eyes. However, even vascularized pedicle and bucket handle flaps retracted 50% of the time. Individuals with SJS were more likely to both require conjunctival rehabilitation after Keratoprosthesis surgery and develop graft retraction in the course of management.

James Chodosh - One of the best experts on this subject based on the ideXlab platform.

  • blood levels of tumor necrosis factor alpha and its type 2 receptor are elevated in patients with boston type i Keratoprosthesis
    Current Eye Research, 2019
    Co-Authors: Eleftherios I Paschalis, Claes H Dohlman, James Chodosh, Kathryn Colby, Elise V. Taniguchi, Louis R. Pasquale, Lucy Q. Shen
    Abstract:

    Purpose: Boston Keratoprosthesis (KPro) patients are prone to glaucoma even with well-controlled intraocular pressure (IOP). Recent experimental data have shown that soluble tumor necrosis factor a...

  • Blood Levels of Tumor Necrosis Factor Alpha and Its Type 2 Receptor Are Elevated in Patients with Boston Type I Keratoprosthesis
    2019
    Co-Authors: Eleftherios I Paschalis, Claes H Dohlman, James Chodosh, Kathryn Colby, Elise V. Taniguchi, Louis R. Pasquale, Lucy Q. Shen
    Abstract:

    Purpose: Boston Keratoprosthesis (KPro) patients are prone to glaucoma even with well-controlled intraocular pressure (IOP). Recent experimental data have shown that soluble tumor necrosis factor alpha (TNF-α) after ocular injury may contribute to progressive retinal damage and subsequent glaucoma. This study evaluates the blood plasma levels of soluble TNF-α, TNF receptors 1 (TNFR1) and 2 (TNFR2), and leptin in patients with Boston type I KPro. Methods: Venous blood samples were collected from KPro patients with glaucoma (KPro G, n = 19), KPro patients without glaucoma (KPro NoG, n = 12), primary angle closure glaucoma without KPro (PACG, n = 13), and narrow angles without glaucoma or KPro (NA, n = 21). TNF-α, TNFR1, TNFR2, and leptin levels were quantified using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) was assessed using the Westergren test. Patients with underlying autoimmune conditions or diabetes were excluded from the study. Results: All groups had similar age, body mass index (BMI), IOP, and ESR (p ≥ 0.11). The mean time from KPro surgery to blood draw was 5.3 ± 3.7 years. Compared to NA patients (0.72 ± 0.3 pg/ml), KPro G and KPro NoG patients had higher blood plasma levels of TNF-α (1.18 ± 0.58 pg/ml, p = 0.006; 1.16 ± 0.50 pg/ml, p = 0.04, respectively). Similarly, KPro G patients had higher blood plasma levels of TNFR2 (2768 ± 1368 pg/ml) than NA patients (2020 ± 435 pg/ml, p = 0.048). In multivariate analysis, KPro status remained positively associated with TNF-α levels (β = 0.36; 95% confidence intervals [CI]: 0.14–0.58; p = 0.002) and TNFR2 levels (β = 458.3; 95% CI: 32.8–883.7; p = 0.035) after adjusting for age, gender, BMI, glaucoma status, and ESR. TNFR1 and leptin levels were not significantly different in the study groups. Conclusions: We detected elevated serum levels of TNF-α and TNFR2 in KPro patients. Longitudinal studies are needed to establish TNF-α and TNFR2 as serum biomarkers related to KPro surgery. Abbreviations: BCVA: best corrected visual acuity; BMI: body mass index; CDR: cup-to-disc ratio; EDTA: ethylenediaminetetraacetic acid; ELISA: enzyme-linked immunosorbent assay; ESR: erythrocyte sedimentation rate; HVF: Humphrey visual field; IOP: intraocular pressure; KPro G: Keratoprosthesis with glaucoma; KPro NoG: Keratoprosthesis without glaucoma; KPro: Keratoprosthesis; MD: mean deviation; NA: narrow angle; non-KPro: without Keratoprosthesis; PACG: primary angle closure glaucoma; RNFL: retinal nerve fiber layer; TNF-α: tumor necrosis factor alpha; TNFR1: tumor necrosis factor receptor 1; TNFR2: tumor necrosis factor receptor 2

  • boston Keratoprosthesis type 1 for limbal stem cell deficiency after severe chemical corneal injury a systematic review
    Ocular Surface, 2018
    Co-Authors: Swapna S Shanbhag, Eleftherios I Paschalis, Hajirah N Saeed, James Chodosh
    Abstract:

    Abstract Purpose To systematically review the published literature on outcomes of Boston Keratoprosthesis type 1 for the treatment of limbal stem cell deficiency secondary to severe chemical corneal injury. Methods Literature searches were conducted in MEDLINE (Ovid), Embase, Web of Science, and the Cochrane Central Register. The main outcome measures assessed were the proportion of eyes with best-corrected visual acuity (BCVA) ≥ 20/200 and the proportion retaining their original Keratoprosthesis, both at the last recorded visit. Results We identified 9 reports in which outcomes of Boston Keratoprosthesis type I implantation after severe chemical injury could be determined, encompassing a total of 106 eyes of 100 patients. There were no randomized controlled studies. The median pre-operative BCVA was hand motion. Vision improved to ≥20/200 in 99/106 (93.4%) eyes after implantation. With a mean follow-up of 24.99 ± 14 months, 68/106 (64.1%) eyes retained BCVA ≥ 20/200 at the last examination. Therefore, 68/99 (68.7%) of those who improved to > 20/200 maintained at least this acuity. The originally implanted device was retained in 88/99 (88.9%) recipients for whom retention was reported. The mean time to failure was 22.36 ± 17.2 months. Glaucomatous optic neuropathy was the most common cause for BCVA Conclusions Implantation of a Boston Keratoprosthesis type I in eyes with corneal blindness after severe chemical ocular injury leads to functional vision in the majority of recipients. Evidence was limited by variability in outcome reporting and an absence of controlled studies..

  • long term visual outcomes and complications of boston Keratoprosthesis type ii implantation
    Ophthalmology, 2017
    Co-Authors: Ramon Lee, Claes H Dohlman, James Chodosh, Ziad Khoueir, Edem Tsikata, Teresa C Chen
    Abstract:

    Purpose To report the long-term visual outcomes and complications after Boston Keratoprosthesis type II implantation in the largest single-center case series with the longest average follow-up. Design Retrospective review of consecutive clinical case series. Participants Between January 1992 and April 2015 at the Massachusetts Eye and Ear Infirmary, 48 eyes of 44 patients had Keratoprosthesis type II implanted by 2 surgeons (C.H.D. and J.C.). Methods For each eye, data were collected and analyzed on the preoperative characteristics, intraoperative procedures, and postoperative course. Main Outcome Measures Visual acuity outcomes, postoperative complications, and device retention. Results The most common indications for surgery were Stevens–Johnson syndrome in 41.7% (20 of 48 eyes) and mucous membrane pemphigoid in 41.7% (20 of 48 eyes). Mean follow-up duration was 70.2 months (standard deviation, 61.8 months; median, 52 months; range, 6 months to 19.8 years). Almost all patients (95.8%, 46 of 48 eyes) had a preoperative visual acuity of 20/200 or worse. Postoperative visual acuity improved to 20/200 or better in 37.5% (18 of 48 eyes) and to 20/100 or better in 33.3% (16 of 48 eyes) at the last follow-up visit. The most common postoperative complication was retroprosthetic membrane formation in over half (60.4%, 29 of 48 eyes). The most pressing postoperative complication was glaucoma onset or progression in about a third. Preexisting glaucoma was present in 72.9% (35 of 48 eyes). Glaucoma progressed in 27.1% (13 of 48 eyes) and was newly diagnosed in 8.3% (4 of 48 eyes) after surgery. Other postoperative complications were tarsorrhaphy revision in 52.1% (25 of 48 eyes), retinal detachment in 18.8% (9 of 48 eyes), infectious endophthalmitis in 6.3% (3 of 48 eyes), and choroidal detachment or hemorrhage in 8.3% (4 of 48 eyes). Half of eyes retained their initial Keratoprosthesis at the last follow-up (50.0%, 24 of 48 eyes). Conclusions The Boston Keratoprosthesis type II is a viable option to salvage vision in patients with poor prognosis for other corneal procedures. Retroprosthetic membranes, Keratoprosthesis retention, and glaucoma are major challenges in the postoperative period; however, the Keratoprosthesis can still provide improved vision in a select group of patients.

  • idiopathic vitritis in the setting of boston Keratoprosthesis
    Cornea, 2015
    Co-Authors: Christina M Grassi, Claes H Dohlman, Alja Crnej, Eleftherios I Paschalis, Kathryn Colby, James Chodosh
    Abstract:

    Purpose:The aim of this study was to revisit the clinical paradigm attributed to Boston Keratoprosthesis recipients presenting with idiopathic vitreous inflammation.Methods:A retrospective chart review was performed of Keratoprosthesis recipients at Massachusetts Eye and Ear Infirmary, from January

Joseph B Ciolino - One of the best experts on this subject based on the ideXlab platform.

  • visual acuity outcomes of the boston Keratoprosthesis type 1 multicenter study results
    American Journal of Ophthalmology, 2016
    Co-Authors: Christopher J Rudnisky, Anthony J Aldave, Claes H Dohlman, James V. Aquavella, Kimberly C Sippel, Joseph B Ciolino, Michael W Belin, Rong Guo, Sadeer B Hannush, Mark J Mannis
    Abstract:

    Purpose To report logarithm of the minimal angle of resolution (logMAR) visual outcomes of the Boston Keratoprosthesis type 1. Design Prospective cohort study. Methods Preoperative, intraoperative, and postoperative parameters of 300 eyes of 300 patients who underwent implantation of a Boston Keratoprosthesis type 1 device between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centers were collected. Results After an average of 17.1 ± 14.8 months, visual acuity improved significantly ( P P P  = .08), sex ( P  = .959), operative side ( P  = .167), or failure ( P  = .494) and final visual acuity. The median time to achieve 20/200 visual acuity was 1 month (95% confidence interval 1.0–6.0) and it was retained for an average of 47.8 months. Multivariate analysis, controlling for preoperative visual acuity, demonstrated 2 factors associated with final visual outcome: chemical injury was associated with better final vision ( P  = .007), whereas age-related macular degeneration was associated with poorer vision ( P Conclusions The Boston Keratoprosthesis type 1 is an effective device for rehabilitation in advanced ocular surface disease, resulting in a significant improvement in visual acuity. Eyes achieved a mean value of 20/150 (0.89 ± 0.64 logMAR units) after 6 months and this was relatively stable thereafter. The best visual prognosis is observed in chemical injury eyes, whereas the worst prognosis is in aniridia, although the latter has limited visual potential.

  • retention of the boston Keratoprosthesis type 1 multicenter study results
    Ophthalmology, 2013
    Co-Authors: Joseph B Ciolino, Michael W Belin, Amit Todani, Khalid Alarfaj, Christopher J Rudnisky
    Abstract:

    Objective To report the retention rate of the Boston Keratoprosthesis type 1 and to identify risk factors for Keratoprosthesis loss. Design Cohort study. Participants A total of 300 eyes of 300 patients who underwent implantation of the Boston Keratoprosthesis type I device between January 2003 and July 2008 by 19 surgeons at 18 medical centers. Methods Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site. Main Outcome Measures Keratoprosthesis retention. Results A total cumulative number of 422 life-years of device implantation are included in this analysis. The average duration of follow-up was 17.1±14.8 months, with a range of 1 week to >6.1 years. Ninety-three percent of the 300 Boston Keratoprosthesis implants were retained at their last follow-up, corresponding to a retention time of 396 patient-years or 1.42 years/Keratoprosthesis. The probability of retention after 1 year and 2 years was 94% and 89%, respectively. During the study period, 21 (7%) eyes failed to retain the device; the reasons for Keratoprosthesis loss include sterile keratolysis (9), fungal infections (8), dense retroprosthetic membranes (3), and bacterial endophthalmitis (1). Multivariate analysis demonstrated 3 independent risk factors for Keratoprosthesis loss: autoimmune cause (hazard ratio [HR], 11.94; 95% confidence interval [CI], 3.31–43.11), ocular surface exposure requiring a concomitant tarsorrhaphy (HR, 3.43; 95% CI, 1.05–11.22), and number of prior failed penetrating keratoplasties (HR, 1.64; 95% CI, 1.18–2.28). Conclusions The Boston Keratoprosthesis type 1 seems to be a viable option for eyes that are not candidates for penetrating keratoplasty (PK). Ocular surface disease due to an autoimmune cause demonstrated the lowest retention rate. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • risk factors for the development of retroprosthetic membranes with boston Keratoprosthesis type 1 multicenter study results
    Ophthalmology, 2012
    Co-Authors: Christopher J Rudnisky, Jared D Ament, Michael W Belin, Amit Todani, Khalid Alarfaj, Brian J Zerbe, Joseph B Ciolino
    Abstract:

    Objective The purpose of this study was to identify possible risk factors for retroprosthetic membrane (RPM) development in a large, multicenter cohort of patients receiving a Boston type 1 Keratoprosthesis. Design Cohort study. Participants The final analysis included 265 eyes of 265 patients who underwent implantation of a Boston Keratoprosthesis type I device between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centers. Methods Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site. Main Outcome Measures The primary outcome was the presence or absence of an RPM during the follow-up period. Results The average age of patients was 63.3±19.1 years, 48.5% of the patients were female, and 52.5% of procedures were performed on the right eye. The mean follow-up time was 17.8±14.9 months. The majority (85.4%; n=222) had undergone an average of 2.2±1.2 (range, 1–8) penetrating keratoplasties before Keratoprosthesis implantation, and 38 eyes (14.6%) received a primary Keratoprosthesis. The overall RPM formation rate was 31.7% (n = 84). The most significant risk factor for RPM development was infectious keratitis (as a surgical indication for Keratoprosthesis surgery itself), resulting in a rate of RPM formation of 70.6%. As an independent risk factor, the hazard ratio (HR) of RPM development in these eyes was 3.20 (95% confidence interval, 1.66–6.17). Aniridia was also an independent risk factor for RPM development (HR, 3.13; 95% confidence interval, 1.10–8.89). Conclusions Formation of RPM is a common complication of Keratoprosthesis surgery, occurring in approximately one-third of cases. Eyes at the highest risk of RPM development are those receiving corneal replacement for infectious keratitis and aniridia. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

  • titanium back plate for a pmma Keratoprosthesis clinical outcomes
    Graefes Archive for Clinical and Experimental Ophthalmology, 2011
    Co-Authors: Amit Todani, James Chodosh, James V. Aquavella, Jared D Ament, Kathryn Colby, Joseph B Ciolino, Michael W Belin, Roberto Pineda, Claes H Dohlman
    Abstract:

    Background/Purpose To compare the rate of retroprosthetic membrane (RPM) formation in Boston Keratoprosthesis (BKPro) with polymethyl methacrylate (PMMA) versus titanium backplates.

  • cost effectiveness of the boston Keratoprosthesis
    American Journal of Ophthalmology, 2010
    Co-Authors: Jared D Ament, James Chodosh, Joseph B Ciolino, Amit Todani, Tomasz P Stryjewski, Claes H Dohlman
    Abstract:

    Purpose To conduct a cost-utility analysis and determine the cost-effectiveness of the Boston Keratoprosthesis (Boston Kpro). Design Retrospective cohort study. Methods setting: The Massachusetts Eye and Ear Infirmary corneal service. patients: Inclusion required a minimum 2-year follow-up. Patients with autoimmune diseases and chemical burns were excluded. Eighty-two patients were included with various indications for surgery. intervention: The Keratoprosthesis is a collar button–shaped polymethylmethacrylate (PMMA) device consisting of 2 curved plates sandwiched around a corneal donor (allo)graft. The device is assembled intraoperatively and sutured to a patient's eye after removing the diseased cornea. main outcome measures: Average cost-effectiveness of the Keratoprosthesis was determined by cost-utility analysis, using expected-value calculations and time-tradeoff utilities. The comparative effectiveness, or gain in quality-adjusted life years (QALYs), was also sought. Cost-effectiveness was compared to recently published data on penetrating keratoplasty (PK). Results A total discounted incremental QALY gain for the Boston Kpro of 0.763 correlated with a conferred QALY gain of 20.3% for the average patient. The average cost-effectiveness of the Keratoprosthesis was $16 140 per QALY. Conclusions Comparable to corneal transplantation, with a cost-effectiveness between $12 000 and $16 000 per QALY, the Keratoprosthesis can be considered highly cost-effective.

Mark J Mannis - One of the best experts on this subject based on the ideXlab platform.

  • visual acuity outcomes of the boston Keratoprosthesis type 1 multicenter study results
    American Journal of Ophthalmology, 2016
    Co-Authors: Christopher J Rudnisky, Anthony J Aldave, Claes H Dohlman, James V. Aquavella, Kimberly C Sippel, Joseph B Ciolino, Michael W Belin, Rong Guo, Sadeer B Hannush, Mark J Mannis
    Abstract:

    Purpose To report logarithm of the minimal angle of resolution (logMAR) visual outcomes of the Boston Keratoprosthesis type 1. Design Prospective cohort study. Methods Preoperative, intraoperative, and postoperative parameters of 300 eyes of 300 patients who underwent implantation of a Boston Keratoprosthesis type 1 device between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centers were collected. Results After an average of 17.1 ± 14.8 months, visual acuity improved significantly ( P P P  = .08), sex ( P  = .959), operative side ( P  = .167), or failure ( P  = .494) and final visual acuity. The median time to achieve 20/200 visual acuity was 1 month (95% confidence interval 1.0–6.0) and it was retained for an average of 47.8 months. Multivariate analysis, controlling for preoperative visual acuity, demonstrated 2 factors associated with final visual outcome: chemical injury was associated with better final vision ( P  = .007), whereas age-related macular degeneration was associated with poorer vision ( P Conclusions The Boston Keratoprosthesis type 1 is an effective device for rehabilitation in advanced ocular surface disease, resulting in a significant improvement in visual acuity. Eyes achieved a mean value of 20/150 (0.89 ± 0.64 logMAR units) after 6 months and this was relatively stable thereafter. The best visual prognosis is observed in chemical injury eyes, whereas the worst prognosis is in aniridia, although the latter has limited visual potential.

  • longer term vision outcomes and complications with the boston type 1 Keratoprosthesis at the university of california davis
    Ophthalmology, 2011
    Co-Authors: Mark A Greiner, Mark J Mannis
    Abstract:

    Purpose To evaluate retention of visual acuity and development of complications after Boston type 1 Keratoprosthesis implantation over a longer follow-up period than previously reported. Design Cohort study. Participants Forty eyes of 35 patients who underwent Boston type 1 Keratoprosthesis surgery at the University of California, Davis, between 2004 and 2010. Methods Preoperative, intraoperative, and postoperative parameters were collected and analyzed. Main Outcome Measures Best-corrected visual acuity (BCVA) and postoperative complications. Results Preoperative visual acuity ranged from 20/150 to light perception and was ≤20/400 in 38 eyes (95%). Preoperative diagnoses included failed corneal transplants (19 eyes, 47.5%), chemical injury (10 eyes, 25%), and aniridia (5 eyes, 12.5%). Mean follow-up duration was 33.6 months (range, 5–72 months). Of 36 eyes followed for ≥1 year, 32 eyes (89%) achieved postoperative BCVA ≥20/200. Of eyes that achieved BCVA ≥20/200, at last follow-up, 19 of 32 eyes (59%) followed for ≥1 year retained BCVA ≥20/200; 16 of 27 eyes (59%) followed for ≥2 years retained BCVA ≥20/200; 7 of 14 eyes (50%) followed for ≥3 years retained BCVA ≥20/200; and 2 of 7 eyes (29%) followed for ≥4 years retained BCVA ≥20/200. End-stage glaucoma most commonly caused vision loss (7 of 13 eyes, 54%) when BCVA ≥20/200 was not retained (follow-up ≥1 year). Glaucoma was newly diagnosed in 11 eyes (27.5%); progression was noted in 9 eyes (22.5%). Glaucoma drainage device erosion occurred in 9 eyes (22.5%). Retroprosthetic membrane formed in 22 eyes (55%), 5 eyes (12.5%) developed endophthalmitis, 6 eyes (15%) developed corneal melt, 7 eyes (17.5%) underwent Keratoprosthesis replacement, and 23 eyes (57.5%) required major surgery to treat postoperative complications. The initial Keratoprosthesis was retained in 32 eyes (80%). Conclusions Keratoprosthesis implantation remains a viable option for salvaging vision. A significant number of patients lost vision over the postoperative course. Glaucoma and complications related to glaucoma surgery are significant challenges to maintaining good vision after Keratoprosthesis surgery. Our study highlights the need for long-term follow-up and a team approach to management, and points to a more guarded long-term visual prognosis after surgery. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • long term complications associated with glaucoma drainage devices and boston Keratoprosthesis
    American Journal of Ophthalmology, 2011
    Co-Authors: Mark A Greiner, James D Brandt, Michele C Lim, Mark J Mannis
    Abstract:

    Purpose To evaluate long-term complications related to glaucoma drainage devices in patients undergoing Boston type 1 Keratoprosthesis surgery. Design Retrospective case series. Methods All patients who underwent Boston type 1 Keratoprosthesis surgery at the University of California, Davis, between 2004 and 2010 were included. Preoperative and postoperative data were reviewed. Twenty-five eyes with glaucoma drainage devices were highlighted. Visual acuity and postoperative complications were tracked at postoperative months 1, 3, 6, 9, and 12 and at annual intervals thereafter. Results Forty eyes of 35 patients were evaluated with an average follow-up of 33.6 months. Conjunctival breakdown occurred in association with 10 glaucoma drainage device implants in 9 eyes. Eleven eyes had glaucoma drainage devices placed before Keratoprosthesis surgery, 3 eyes underwent glaucoma drainage device placement at the time of surgery, and 2 eyes had a glaucoma drainage device placed after surgery. All but one of the eroded glaucoma drainage devices were placed before surgery. Associated complications included endophthalmitis, hypotony, and Keratoprosthesis extrusion, with 6 glaucoma drainage devices requiring removal. Long-term beset-corrected visual acuity was maintained better in eyes in which glaucoma drainage device erosions did not develop. Conclusions One of the main challenges with Keratoprosthesis surgery is treating concurrent glaucoma. Glaucoma drainage devices have been advocated as a way to address this long-term complication, but this series suggests that glaucoma drainage device-related complications can cause significant vision loss.

  • boston type 1 Keratoprosthesis the university of california davis experience
    Cornea, 2009
    Co-Authors: Jay C Bradley, Enrique Hernandez, Ivan R Schwab, Mark J Mannis
    Abstract:

    Purpose:To compare the University of California Davis experience using the Boston Keratoprosthesis with the Boston Keratoprosthesis Study Group's initial report.Design:Retrospective chart review.Participants:We analyzed 30 eyes of 28 patients who previously underwent Boston type 1 Keratoprosthesis s

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