Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(1):050-055 | DOI: 10.5507/bp.2012.040

Histologic evaluation of AlphaCor keratoprosthesis explanted following various complications

Nada Jiraskovaa, Liliana Wernerb, Nick Mamalisb, Pavel Rozsivala
a Department of Ophthalmology, University Hospital, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
b John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT-84132, USA

Aims: To report the histological findings in two AlphaCor artificial corneas explanted following complications,to compare the mechanism of biointegration and/or failure of the device and the correlation with clinical histories.

Methods: The first patient was diagnosed with optic deposits and corneal melting during the late postoperative period and required the removal of the device. The second patient experienced injury with penetration of the device 5 months after implantation. The explanted devices embedded within the corneal tissues were processed for pathological analysis at the John A. Moran Eye Center, University of Utah, Salt Lake City, USA. Histologic findings were compared with earlier histological results from animal studies and human case series and correlated with clinical histories.

Results: Both devices demonstrated normal skirt porosity. Light microscopic examination of the specimens disclosed adequate biointegration - colonization of the peripheral skirt with cellular elements present within the pores of the skirt. In the first patient (specimen 1) epithelial ingrowth was observed between the peripheral skirt and the posterior surface of the specimen, with partial extrusion of the device in that area. In the second case (specimen 2) the central, optic component of the device was missing.

Conclusion: Histologic findings of the AlphaCor skirt were consistent with earlier animal studies and human cases series reports. These findings confirm the occurrence of biointegration. Epithelial ingrowth and scattered chronic mononuclear inflammatory cells were observed in the area of partial extrusion in the patient with a history of melting prior to explantation.

Keywords: AlphaCor, keratoprosthesis, biointegration, histology

Received: October 3, 2011; Accepted: April 4, 2012; Prepublished online: June 1, 2012; Published: April 1, 2014  Show citation

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Jiraskova, N., Werner, L., Mamalis, N., & Rozsival, P. (2014). Histologic evaluation of AlphaCor keratoprosthesis explanted following various complications. Biomedical papers158(1), 050-055. doi: 10.5507/bp.2012.040
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References

  1. Coassin M, Zhang C, Green WR, Acquavella JV, Akpek EK. Histopathologic and Immunologic Aspects of AlphaCor Artificial Corneal Failure. Am J Ophthalmol 2007;144:699-704. Go to original source... Go to PubMed...
  2. Hicks CR, Crawford GJ, Dart JKG, Grabner G, Holland E, Stulting RD, Tan DT, Bulsara M. AlphaCor Clinical Outcomes Cornea 2006;25:1034-42. Go to original source... Go to PubMed...
  3. Chirila TV, Vijayasekaran S, Horne R, Interpenetrating polymer network (IPN) as a permanent joint between the elements of a new type of artificial cornea. J Biomed Mater Res 1994;28:745-53. Go to original source... Go to PubMed...
  4. Hicks CR, Chirila TV, Werner L ,Crawford GJ, Apple DJ, Constable IJ. Deposits in artificial corneas: risk factors and prevention. Clin Experiment Ophthalmol 2004;32:185-91. Go to original source... Go to PubMed...
  5. Chirila TV, Morrison DA, Hicks CR, Gridneva Z, Barry CJ, Vijayasekaran, S. In vitro drug-induced spoliation of a keratoprosthetic hydrogel. Cornea 2004;23:620-9. Go to original source... Go to PubMed...
  6. Hicks CR, Hamilton S. Retroprosthetic membranes in AlphaCor patients: risk factors and prevention. Cornea 2005;24:692-8. Go to original source... Go to PubMed...
  7. Netland PA, Terada H, Dohlman CH. Glaucoma associated with keratoprosthesis. Ophthalmology 1998;105:751-7. Go to original source... Go to PubMed...
  8. Nouri M, Terada H, Alfonso EH, Foster CS, Durand ML, Dohlman CH.. Endophthalmitis after keratoprosthesis: incidence, bacterial causes, and risk factors. Arch Ophthalmol 2001;119:484-9. Go to original source... Go to PubMed...
  9. Chirila TV, Thompson-Wallis DE, Crawford GJ, Constable IJ, Vijayasekaran S. Production of neocollagen by cells invading hydrogel sponges implanted in the rabbit cornea. Graefes Arch Clin Exp Ophthalmol 1996;234:193-8. Go to original source... Go to PubMed...
  10. Fitton JH, Ziegelaar BW, Hicks CR, Clayton AB, Crawford GJ, Constable IJ, Chirila TV. Assessment of anticollagenase treatments after insertion of a keratoprosthetic material in the rabbit cornea. Cornea 1998;17:108-14. Go to original source... Go to PubMed...
  11. Hicks CR, Chirila TV, Clayton AB, Fitton JH, Vijayasekaran S, Dalton PD, Lou X, Platten S, Ziegelaar B, Hong Y, Crawford GJ, Constable IJ. Clinical results of implantation of the Chirila keratoprosthesis in rabbits. Br J Ophthalmol 1998;82:18-25. Go to original source... Go to PubMed...
  12. Hicks CR, Chirila TV, Dalton PD, Clayton AB, Vijayasekaran S, Crawford GJ, Constable IJ . Keratoprosthesis: preliminary results of an artificial corneal buton as a full-thickness implant in the rabbit model. Aust N Z J Ophthalmol 1996;24:297-303. Go to original source... Go to PubMed...
  13. Vijayasekaran S, Hicks CR, Chirila TV, Fitton JH, Clayton AB, Lou X, Platten ST, Crawford GJ, Constable IJ. Histologic evaluation during healing of hydrogel core-and-skirt keratoprostheses in the rabbit eye. Cornea 1997;16:352-9. Go to original source... Go to PubMed...
  14. Vijayasekaran S, Fitton JH, Hicks CR, Chirila TV, Crawford GJ, Constable IJ. . Cell viability and inflammatory response in hydrogel sponges implanted in the rabbit cornea. Biomaterials 1998;19:2255-67. Go to original source... Go to PubMed...
  15. Hicks CR, Werner L, Vijayasekaran S, Mamalis N, Apple DJ. Histology of AlphaCor skirts: evaluation of biointegration. Cornea 2005;24:933-40. Go to original source... Go to PubMed...
  16. Hicks CR, Vijayasekaran S, Chirila TV, Platten ST, Crawford GJ, Constable IJ. Implantation of PHEMA keratoprostheses after alkali burns in rabbit eyes. Cornea 1998;17:301-8. Go to original source... Go to PubMed...