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Liu M, Wen H, Lin L, Ge C, Guo L, Chodosh J, Zheng Q, Chen W. Short-Term Outcomes of Modified Boston Type-II Keratoprosthesis Implantation With Autologous Auricular Cartilage Reinforcement. Am J Ophthalmol 2023; 252:205-212. [PMID: 36934958 DOI: 10.1016/j.ajo.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/29/2023] [Accepted: 03/03/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To report the short-term visual outcomes and complications of a modified Boston Type-II keratoprosthesis (Kpro) procedure. DESIGN Retrospective case series. METHODS Thirty-seven eyes of 37 patients who had an implantation of autologous auricular cartilage-reinforced (AACR) Boston Type-II Kpro (BK2) were included in the current study. Preoperative and postoperative data were recorded and analyzed for each eye. Main outcome measures included best-corrected visual acuity, symptoms as assessed by questionnaires, complications associated with implantation, and retention of the implanted BK2 device. RESULTS A total of 37 eyes, consisting of 19 with severe autoimmune dry eye (ADE) and 18 with burn injury, completed ≥12 months of follow-up. The median (interquartile range) best-corrected visual acuity at baseline, 1 month, 3 months, 6 months, 1 year, and 2 years of follow-up was hand motion (HM) 20/60 (20/100-20/40), 20/60 (20/200-20/40), 20/60 (20/200-20/40), 20/100 (20/200-20/40), and 20/100 (20/400-20/40), respectively. All eyes retained the initial device (37/37, 100%). Common postoperative complications included retroprosthetic membrane (n = 21), de novo glaucoma (n = 7), endophthalmitis (n = 1), and conjunctival erosion (n = 4). No ear complications were discovered during follow-up assessments. The ocular surface disease index score improved from baseline to a 2-year follow-up (median 57.5 vs 21.43). CONCLUSION The modified AACR-BK2 procedure could be considered to restore vision in patients with end-stage corneal blindness.
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Affiliation(s)
- Mimi Liu
- From the National Clinical Research Center for Ocular Diseases (M.L., H.W., L.L., C.G., L.G., Q.Z., W.C.), Eye Hospital, Wenzhou Medical University, Wenzhou, China; Department of Ophthalmology (M.L., L.G., W.C.), Boao Super Hospital, Hainan, China
| | - Han Wen
- From the National Clinical Research Center for Ocular Diseases (M.L., H.W., L.L., C.G., L.G., Q.Z., W.C.), Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lei Lin
- From the National Clinical Research Center for Ocular Diseases (M.L., H.W., L.L., C.G., L.G., Q.Z., W.C.), Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chaoxiang Ge
- From the National Clinical Research Center for Ocular Diseases (M.L., H.W., L.L., C.G., L.G., Q.Z., W.C.), Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lili Guo
- From the National Clinical Research Center for Ocular Diseases (M.L., H.W., L.L., C.G., L.G., Q.Z., W.C.), Eye Hospital, Wenzhou Medical University, Wenzhou, China; Department of Ophthalmology (M.L., L.G., W.C.), Boao Super Hospital, Hainan, China
| | - James Chodosh
- Department of Ophthalmology and Visual Sciences (J.C.), School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Qinxiang Zheng
- From the National Clinical Research Center for Ocular Diseases (M.L., H.W., L.L., C.G., L.G., Q.Z., W.C.), Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei Chen
- From the National Clinical Research Center for Ocular Diseases (M.L., H.W., L.L., C.G., L.G., Q.Z., W.C.), Eye Hospital, Wenzhou Medical University, Wenzhou, China; Department of Ophthalmology (M.L., L.G., W.C.), Boao Super Hospital, Hainan, China.
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Ortiz-Morales G, Loya-Garcia D, Colorado-Zavala MF, Gomez-Elizondo DE, Soifer M, Srinivasan B, Agarwal S, Rodríguez-Garcia A, Perez VL, Amescua G, Iyer G. The evolution of the modified osteo-odonto-keratoprosthesis, its reliability, and long-term visual rehabilitation prognosis: An analytical review. Ocul Surf 2022; 24:129-144. [DOI: 10.1016/j.jtos.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
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Metcalfe D, Iqbal O, Chodosh J, Bouchard CS, Saeed HN. Acute and Chronic Management of Ocular Disease in Stevens Johnson Syndrome/Toxic Epidermal Necrolysis in the USA. Front Med (Lausanne) 2021; 8:662897. [PMID: 34322500 PMCID: PMC8311126 DOI: 10.3389/fmed.2021.662897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
Stevens Johnson syndrome and toxic epidermal necrolysis are on a spectrum of a severe, immune-mediated, mucocutaneous disease. Ocular involvement occurs in the vast majority of cases and severe involvement can lead to corneal blindness. Treatment in the acute phase is imperative in mitigating the severity of chronic disease. Advances in acute treatment such as amniotic membrane transplantation have shown to significantly reduce the severity of chronic disease. However, AMT is not a panacea and severe chronic ocular disease can and does still occur even with aggressive acute treatment. Management of chronic disease is equally critical as timely intervention can prevent worsening of disease and preserve vision. This mini-review describes the acute and chronic findings in SJS/TEN and discusses medical and surgical management strategies.
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Affiliation(s)
- Derek Metcalfe
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, United States
| | - Omer Iqbal
- Loyola University Medical Center, Maywood, IL, United States
| | - James Chodosh
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, United States
| | | | - Hajirah N Saeed
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, United States
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Enomoto A, Fukuda M, Matsunaga K, Kusaka S, Shimomura Y, Hamada S. Contribution to oral and maxillary surgery and surgical technique of osteo-odontokeratoprosthesis in Japan. Br J Oral Maxillofac Surg 2019; 57:861-865. [PMID: 31378404 DOI: 10.1016/j.bjoms.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
Osteo-odontokeratoprosthesis (OOKP) is a technique invented by Strampelli in 1963, in which the patient's own tooth root is used to support an optical cylinder. It uses an autologous tooth-bone-periodontal complex to mount an optical cylinder, which is stabilised by overlying autologous buccal mucosa. OOKP involves two, staged procedures done by ophthalmologists and oral surgeons, and the main contribution from the oral surgeon is during the first stage. To date we have done nine first-stage, and completed eight second-stage, OOKP operations in Japan with a mean follow-up of eight years and 11 months by modifying the original method of the oral surgery. All OOKP procedures were unilateral, and canines were selected as the donor teeth. Patients developed ocular blindness as a result of Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and chemical and thermal burns to the cornea and ocular surface. All eight patients who completed the second stage have been stable, and there have been no major perioperative or postoperative oral complications. The patients' visual acuities were stable with no serious complications. Here we report the technical details of the oral contribution to OOKP.
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Affiliation(s)
- A Enomoto
- Department of Oral and Maxillofacial Surgery, Kindai University, Faculty of Medicine, Japan.
| | - M Fukuda
- Department of Ophthalmology, Kindai University, Faculty of Medicine, Japan
| | - K Matsunaga
- Department of Oral and Maxillofacial Surgery, Kindai University, Faculty of Medicine, Japan
| | - S Kusaka
- Department of Ophthalmology, Kindai University, Faculty of Medicine, Japan
| | - Y Shimomura
- Department of Ophthalmology, Fuchu Hospital, Japan
| | - S Hamada
- Department of Oral and Maxillofacial Surgery, Kindai University, Faculty of Medicine, Japan
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Enomoto A, Matsunaga K, Fukuda M, Shimomura Y, Hamada S. Application of a resin handle for preparation of lamina for osteo-odontokeratoprosthesis. Br J Oral Maxillofac Surg 2018; 56:554-555. [DOI: 10.1016/j.bjoms.2018.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/25/2018] [Indexed: 11/24/2022]
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Arora A, Pandey SK, Roychoudhury A, Bhutia O, Tandon R, Gagnani SP, Yadav R. Piezoelectric harvest of osteo-odonto-lamina in modified osteo-odonto keratoprosthesis: A maxillofacial perspective. Natl J Maxillofac Surg 2018; 9:167-173. [PMID: 30546231 PMCID: PMC6251291 DOI: 10.4103/njms.njms_32_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: We describe the piezo-osteotomy feasibility in rehabilitation and harvesting of osteo-odonto lamina in modified osteo-odonto keratoprosthesis (MOOKP) surgery. Surgery was evaluated regarding operative technique and success of the keratoprosthesis (KPros) in terms of perception to light (+ve) to finger counting (+ve). Materials and Methods: This retrospective cohort study included 12 patients undergone MOOKP surgery procedures. Harvesting of osteo-odonto-lamina was performed using piezosurgical osteotomy during 2007–2012. Results: The mean follow up was 34 months (range 24–48 months). Of the 12 patients six patients had vision ≥6/12, four patients had vision <6/12, but >6/60 and one patients had vision ≤6/60. KPros was retained and functional in all the eyes after a minimum follow up of 24 months. There was mucosal overgrowth over the optical cylinder occurred in two cases over 4 years follow up which was corrected with trimming. Postoperative complication at donor site was seen in three cases, two cases with exposure of root of adjacent teeth and oro antral fistula in one. Conclusions: This study suggests that piezoelectric harvest of osteo-odonto-lamina is a valuable surgical option in patients undergoing MOOKP surgery, resulting in high success rate with less complication.
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Affiliation(s)
- Ankit Arora
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Kumar Pandey
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Parvez Gagnani
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Kohanim S, Palioura S, Saeed HN, Akpek EK, Amescua G, Basu S, Blomquist PH, Bouchard CS, Dart JK, Gai X, Gomes JAP, Gregory DG, Iyer G, Jacobs DS, Johnson AJ, Kinoshita S, Mantagos IS, Mehta JS, Perez VL, Pflugfelder SC, Sangwan VS, Sippel KC, Sotozono C, Srinivasan B, Tan DTH, Tandon R, Tseng SCG, Ueta M, Chodosh J. Acute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease. Ocul Surf 2016; 14:168-88. [PMID: 26882981 DOI: 10.1016/j.jtos.2016.02.001] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 02/07/2023]
Abstract
Our purpose is to comprehensively review the state of the art with regard to Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to improving the management of associated ocular surface complications. SJS and TEN are two ends of a spectrum of immune-mediated disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. Part I of this review focused on the systemic aspects of SJS/TEN and was published in the January 2016 issue of this journal. The purpose of Part II is to summarize the ocular manifestations and their management through all phases of SJS/TEN, from acute to chronic. We hope this effort will assist ophthalmologists in their management of SJS/TEN, so that patients with this complex and debilitating disease receive the best possible care and experience the most optimal outcomes in their vision and quality of life.
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Affiliation(s)
- Sahar Kohanim
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, USA
| | - Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | - Hajirah N Saeed
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | | | | | | | - John K Dart
- Moorfields Eye Hospital, NHS Foundation Trust, UK
| | - Xiaowu Gai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
| | | | - Darren G Gregory
- Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, USA
| | - Geetha Iyer
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Deborah S Jacobs
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA; Boston Foundation for Sight, USA
| | | | | | | | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | | | | | | | | | - Bhaskar Srinivasan
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, India
| | - Scheffer C G Tseng
- Ocular Surface Center, Ocular Surface Research & Education Foundation, USA
| | - Mayumi Ueta
- Kyoto Prefectural University of Medicine, Japan
| | - James Chodosh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA.
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Farias CC, Ozturk HE, Albini TA, Berrocal AM, Amescua G, Betancurt C, Parel JM, Oliveros MC, Gibbons A, Vargas JM, Perez VL. Use of intraocular video endoscopic examination in the preoperative evaluation of keratoprosthesis surgery to assess visual potential. Am J Ophthalmol 2014; 158:80-86.e2. [PMID: 24582996 DOI: 10.1016/j.ajo.2014.02.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the clinical utility of intraocular videoendoscopy examination for the evaluation of the retina and optic nerve in patients being considered for a Boston type I keratoprosthesis (KPro). DESIGN Interventional case series study. METHODS Ten patients with a history of corneal blindness caused by failed penetrating keratoplasty (PK) and inability to accurately assess visual potential were included in this study. Ophthalmologic examination, B-scan ultrasonography, and pars plana videoendoscopy were carried out to assess the retina and optic nerve before KPro. RESULTS Posterior segment examination was successfully used to evaluate the retina and optic nerve of all patients with opaque corneas. Out of 10 patients that underwent endoscopic examination, 3 (30%) were considered to be adequate candidates for KPro surgery and 7 (70%) were not. This was based on visualized retinal disease and/or optic nerve pathology. Of the 3 patients that underwent KPro surgery, all of them had a significant improvement of vision, including counting fingers to 20/100, hand motion to 20/5, and light perception to 20/80, as suggested by the endoscopy preoperative examination. No complications of the endoscopy procedure were observed. CONCLUSIONS This report demonstrates the successful use of intraocular videoendoscopy to rule out threats to a good visual outcome for patients being considered as candidates for KPro. Direct visualization of the posterior segment can be part of the preoperative algorithm in the decision process of performing a KPro surgery in patients when visual potential is questionable.
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Affiliation(s)
- Charles C Farias
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Hilal E Ozturk
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Carolina Betancurt
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jean-Marie Parel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary C Oliveros
- Department of Ophthalmology, Cornea Service, Centro Oftalmologico de Valencia, Valencia, Venezuela
| | - Allister Gibbons
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jose M Vargas
- Department of Ophthalmology, Cornea Service, Centro Oftalmologico de Valencia, Valencia, Venezuela
| | - Victor L Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Osteo-odonto-keratoprosthesis - a maxillofacial perspective. J Craniomaxillofac Surg 2012; 40:e426-31. [PMID: 22425501 DOI: 10.1016/j.jcms.2012.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 11/23/2022] Open
Abstract
The OOKP (osteo-odonto-keratoprosthesis) is the treatment of choice for conditions like Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, multiple failed grafts and chemical burns which are not amenable to penetrating keratoplasty. The OOKP is an autograft which replaces the cornea with a polymethacrylate cylinder mounted on a tooth-bone complex. The aim of this paper was to retrospectively analyze the records in 26 patients undergoing OOKP surgery between 2007 and 2011. The paper describes our experience with the procedure, with emphasis on its oral and maxillofacial aspects and management of associated complications. The aetiology of blindness in 23 patients was Stevens-Johnson's syndrome and chemical burns in three. Twenty-two patients had their maxillary canines, two had mandibular canines and two had maxillary first premolars as the choice of donor tooth. An oroantral fistula developed in four patients. One patient needed to undergo a surgical procedure for closure of the same. Roots of adjacent teeth were exposed in 12 patients. Twenty-four patients underwent both stages of the procedure with 19 being visually rehabilitated successfully. There was no improvement in the vision of four patients. One patient was lost to follow-up. Two patients have yet to undergo Stage 2.
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