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. 1998 Jan;82(1):18–25. doi: 10.1136/bjo.82.1.18

Clinical results of implantation of the Chirila keratoprosthesis in rabbits

C Hicks 1, T Chirila 1, A Clayton 1, J Fitton 1, S Vijayasekaran 1, P Dalton 1, X Lou 1, S Platten 1, B Ziegelaar 1, Y Hong 1, G Crawford 1, I Constable 1
PMCID: PMC1722337  PMID: 9536874

Abstract

AIMS/BACKGROUND—An ideal keratoprosthesis (KPro) would closely resemble a donor corneal button in terms of its surgical handling, optics, and capacity to heal with host tissue in order to avoid many of the complications associated with the KPros which are currently in clinical use. This study was carried out to assess the long term clinical outcomes on implantation of the core and skirt poly(2-hydroxyethyl methacrylate) KPro in animals.
METHODS—20 KPros were made and implanted as full thickness corneal replacements into rabbits and followed for up to 21 months to date.
RESULTS—80% of the prostheses have been retained, with a low incidence of complications such as cataract, glaucoma, and retroprosthetic membrane formation which are frequently associated with KPro surgery.
CONCLUSIONS—KPros of this type may offer promise in the treatment of patients for whom penetrating keratoplasty with donor material carries a poor prognosis. Refinement of the KPro and further animal trials, including implantation into abnormal corneas, are however mandatory before human implantation could be planned.

 Keywords: complications; keratoprosthesis; optics; PHEMA

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Figure 1  .

Figure 1  

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The Chirila KPro.

Figure 2  .

Figure 2  

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Peroperative appearance (rabbit D3) during formation of the conjunctival flap.

Figure 3  .

Figure 3  

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Postoperative appearance (rabbit D6) at 6 months.

Figure 4  .

Figure 4  

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Histological section stained with toluidine blue of the skirt of the KPro removed 2 months after implantation in rabbit D4, showing fibroblasts (× 400).

Figure 5  .

Figure 5  

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Histological section of the skirt of the KPro removed 5 months after implantation in rabbit M1, stained with 2% alizarin red; specks of calcium can be seen (× 100).

Figure 6  .

Figure 6  

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(a) Histological section of a PHEMA gel in which pores can be seen (× 400). (b) Photograph of a whole mount preparation of a PHEMA gel after 1 week in an in vitro calcifying solution, stained with 2% Alizarin red and destained with acetone to demonstrate calcium deposition within a pore in the gel (× 400).

Figure 7  .

Figure 7  

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Rabbit corneal epithelial cell outgrowth from a donor button onto a PHEMA sponge specimen in vitro (a) in section, stained with toluidine blue (×200) and (b) surface view (arrow indicates the edge of the advancing sheet of cells).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bland J. M., Altman D. G. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet. 1995 Oct 21;346(8982):1085–1087. doi: 10.1016/s0140-6736(95)91748-9. [DOI] [PubMed] [Google Scholar]
  2. Bland J. M., Altman D. G. Comparing two methods of clinical measurement: a personal history. Int J Epidemiol. 1995;24 (Suppl 1):S7–14. doi: 10.1093/ije/24.supplement_1.s7. [DOI] [PubMed] [Google Scholar]
  3. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  4. Caprioli J., Klingbeil U., Sears M., Pope B. Reproducibility of optic disc measurements with computerized analysis of stereoscopic video images. Arch Ophthalmol. 1986 Jul;104(7):1035–1039. doi: 10.1001/archopht.1986.01050190093046. [DOI] [PubMed] [Google Scholar]
  5. Chauhan B. C., LeBlanc R. P., McCormick T. A., Rogers J. B. Test-retest variability of topographic measurements with confocal scanning laser tomography in patients with glaucoma and control subjects. Am J Ophthalmol. 1994 Jul 15;118(1):9–15. doi: 10.1016/s0002-9394(14)72836-3. [DOI] [PubMed] [Google Scholar]
  6. Cioffi G. A., Robin A. L., Eastman R. D., Perell H. F., Sarfarazi F. A., Kelman S. E. Confocal laser scanning ophthalmoscope. Reproducibility of optic nerve head topographic measurements with the confocal laser scanning ophthalmoscope. Ophthalmology. 1993 Jan;100(1):57–62. [PubMed] [Google Scholar]
  7. Dandona L., Quigley H. A., Jampel H. D. Reliability of optic nerve head topographic measurements with computerized image analysis. Am J Ophthalmol. 1989 Oct 15;108(4):414–421. doi: 10.1016/s0002-9394(14)73309-4. [DOI] [PubMed] [Google Scholar]
  8. Dandona L., Quigley H. A., Jampel H. D. Variability of depth measurements of the optic nerve head and peripapillary retina with computerized image analysis. Arch Ophthalmol. 1989 Dec;107(12):1786–1792. doi: 10.1001/archopht.1989.01070020868029. [DOI] [PubMed] [Google Scholar]
  9. Dreher A. W., Tso P. C., Weinreb R. N. Reproducibility of topographic measurements of the normal and glaucomatous optic nerve head with the laser tomographic scanner. Am J Ophthalmol. 1991 Feb 15;111(2):221–229. doi: 10.1016/s0002-9394(14)72263-9. [DOI] [PubMed] [Google Scholar]
  10. Kessing S. V., Gregersen E. The distended disc in early stages of congenital glaucoma. Acta Ophthalmol (Copenh) 1977 Jun;55(3):431–435. doi: 10.1111/j.1755-3768.1977.tb06119.x. [DOI] [PubMed] [Google Scholar]
  11. Kruse F. E., Burk R. O., Völcker H. E., Zinser G., Harbarth U. Reproducibility of topographic measurements of the optic nerve head with laser tomographic scanning. Ophthalmology. 1989 Sep;96(9):1320–1324. doi: 10.1016/s0161-6420(89)32719-9. [DOI] [PubMed] [Google Scholar]
  12. Mikelberg F. S., Douglas G. R., Schulzer M., Cornsweet T. N., Wijsman K. Reliability of optic disk topographic measurements recorded with a video-ophthalmograph. Am J Ophthalmol. 1984 Jul 15;98(1):98–102. doi: 10.1016/0002-9394(84)90194-6. [DOI] [PubMed] [Google Scholar]
  13. Miller J. M., Caprioli J. An optimal reference plane to detect glaucomatous nerve fiber layer abnormalities with computerized image analysis. Graefes Arch Clin Exp Ophthalmol. 1992;230(2):124–128. doi: 10.1007/BF00164649. [DOI] [PubMed] [Google Scholar]
  14. Pederson J. E., Anderson D. R. The mode of progressive disc cupping in ocular hypertension and glaucoma. Arch Ophthalmol. 1980 Mar;98(3):490–495. doi: 10.1001/archopht.1980.01020030486010. [DOI] [PubMed] [Google Scholar]
  15. Portney G. L. Photogrammetric analysis of the three-dimensional geometry of normal and glaucomatous optic cups. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1976 Mar-Apr;81(2):239–246. [PubMed] [Google Scholar]
  16. Rohrschneider K., Burk R. O., Kruse F. E., Völcker H. E. Reproducibility of the optic nerve head topography with a new laser tomographic scanning device. Ophthalmology. 1994 Jun;101(6):1044–1049. doi: 10.1016/s0161-6420(94)31220-6. [DOI] [PubMed] [Google Scholar]
  17. Rohrschneider K., Burk R. O., Völcker H. E. Reproducibility of topometric data acquisition in normal and glaucomatous optic nerve heads with the laser tomographic scanner. Graefes Arch Clin Exp Ophthalmol. 1993 Aug;231(8):457–464. doi: 10.1007/BF02044232. [DOI] [PubMed] [Google Scholar]
  18. Shields M. B., Martone J. F., Shelton A. R., Ollie A. R., MacMillan J. Reproducibility of topographic measurements with the optic nerve head analyzer. Am J Ophthalmol. 1987 Dec 15;104(6):581–586. doi: 10.1016/0002-9394(87)90167-x. [DOI] [PubMed] [Google Scholar]
  19. Spaeth G. L., Hitchings R. A., Sivalingam E. The optic disc in glaucoma: pathogenetic correlation of five patterns of cupping in chronic open-angle glaucoma. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1976 Mar-Apr;81(2):217–223. [PubMed] [Google Scholar]
  20. Varma R., Steinmann W. C., Spaeth G. L., Wilson R. P. Variability in digital analysis of optic disc topography. Graefes Arch Clin Exp Ophthalmol. 1988;226(5):435–442. doi: 10.1007/BF02170004. [DOI] [PubMed] [Google Scholar]

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