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Collagen cross-linking of the Boston keratoprosthesis donor carrier to prevent corneal melting in high-risk patients.
[aniridia]
To
examine
the
clinical
relevance
and
pathophysiology
of
Boston
keratoprosthesis
(
B-KPro
)
-
related
corneal
keratolysis
(
cornea
melt
)
and
to
describe
a
novel
method
of
preventing
corneal
melt
using
ex
vivo
crosslinked
cornea
tissue
carrier
.
A
review
of
B-KPro
literature
was
performed
to
highlight
cases
of
corneal
melt
.
Studies
examining
the
effect
of
corneal
collagen
cross-linking
(
CXL
)
on
the
biomechanical
properties
of
corneal
tissue
are
summarized
.
The
use
of
crosslinked
corneal
tissue
as
a
carrier
to
the
B-KPro
is
illustrated
with
a
case
.
Corneal
melting
after
B-KPro
is
a
relatively
rare
event
,
occurring
in
3
%
of
eyes
during
the
first
3
years
of
postoperative
follow-up
.
The
risk
of
post-
KPro
corneal
melting
is
heightened
in
eyes
with
chronic
ocular
surface
inflammation
such
as
eyes
with
Stevens-
Johnson
syndrome
and
mucous
membrane
pemphigoid
.
This
chronic
inflammation
results
in
high
tear
levels
of
matrix
metalloproteinases
,
the
enzymes
responsible
for
collagenolysis
and
corneal
melt
.
Crosslinked
corneal
tissue
has
been
shown
to
have
stiffer
biomechanical
properties
and
to
be
more
resistant
to
degradation
by
collagenolytic
enzymes
.
We
have
previously
optimized
the
technique
for
ex
vivo
corneal
CXL
and
are
currently
studying
its
impact
on
the
prevention
of
corneal
melting
after
B-KPro
surgery
in
high
-risk
eyes
.
Crosslinked
carrier
tissue
was
used
in
a
52
-
year
-old
man
with
familial
aniridia
and
severe
post-
KPro
corneal
melt
.
The
patient
maintained
his
visual
acuity
and
showed
no
evidence
of
corneal
thinning
or
melt
in
the
first
postoperative
year
.
Collagen
crosslinking
was
previously
shown
to
halt
the
enzymatic
degradation
of
corneal
buttons
ex
vivo
.
This
study
demonstrates
the
safety
and
potential
benefit
of
using
crosslinked
corneal
grafts
as
carriers
for
the
B-KPro
,
especially
in
eyes
at
higher
risk
of
postoperative
melt
.
Diseases
Validation
Diseases presenting
"chronic ocular surface inflammation"
symptom
aniridia
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