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| 2. |
- Behaegel, Josephine, et al.
(författare)
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Outcomes of Human Leukocyte Antigen-Matched Allogeneic Cultivated Limbal Epithelial Transplantation in Aniridia-Associated Keratopathy-A Single-Center Retrospective Analysis
- 2022
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Ingår i: Cornea. - : LIPPINCOTT WILLIAMS & WILKINS. - 0277-3740 .- 1536-4798. ; 41:1, s. 69-77
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess the efficacy and safety of human leukocyte antigen-matched allogeneic cultivated limbal epithelial stem cell grafts in the treatment of aniridia-associated keratopathy (AAK). Methods: Six eyes of 6 patients with severe AAK received an allogeneic stem cell graft between January 2010 and March 2017. Anatomical and functional results were assessed at 6 months, 1 year, 2 years, and the final follow-up visit available. Safety analysis was performed by considering all perioperative and postoperative adverse events and additional surgeries required during the follow-up period. Results: The mean follow-up was 53.6 months (range 24-104 months). In most patients (80%), there was an early improvement of the keratopathy postoperatively, which slowly regressed during longer follow-up. At the final follow-up, 4 of the eyes were graded as failure and 1 eye was graded as partial success. Grading the sixth eye was not possible because of an adverse event. None of the patients maintained a total anatomical success in the long-term. Only 1 patient maintained a modest improvement in best-corrected visual acuity from hand motion to counting fingers. Four serious adverse events were recorded in 2 patients. Conclusions: Severe AAK remains a challenging condition to manage. Transplantation of allogenic ex vivo cultivated limbal stem cells may provide a temporary improvement in ocular surface stability, but anatomical and functional results are poor in the long-term. The eyes are prone to adverse events, and any surgical treatment should take this into consideration.
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| 4. |
- Bentley, E, et al.
(författare)
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Biosynthetic Corneal Substitute Implantation in Dogs
- 2010
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Ingår i: Cornea. - : LWW. - 0277-3740 .- 1536-4798. ; 29:8, s. 910-916
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess integration of a biosynthetic corneal implant in dogs. Methods: Three normal adult laboratory Beagles underwent ophthalmic examinations, including slit-lamp biomicroscopy, indirect ophthalmoscopy, applanation tonometry, and Cochet-Bonnet aesthesiometry. Biosynthetic corneas fabricated from glutaraldehyde crosslinked collagen and copolymers of collagen and poly (N-isopropylacrylamide-co-acrylic acid-co-acryloxysuccinimide, denoted as TERP) were implanted into dogs by a modified epikeratoplasty technique. Ophthalmic examinations and aesthesiometry were performed daily for 5 days and then weekly thereafter for 16 weeks. Corneal samples underwent histopathological and transmission electron microscopy examination at 16 weeks. Results: Implants were epithelialized by 7 days. Intraocular pressure was within normal range throughout the study. Aesthesiometry values dropped from an average of 3.67 cm preoperatively to less than 1 mm for all dogs for the first postoperative weeks. By week 16, the average Cochet-Bonnet value was 1.67 cm, demonstrating partial recovery of functional innervation of the implant. No inflammation or rejection of the implant occurred, and minimal haze formation was noted. Light microscopy revealed thickened but normal epithelium over the implant with fibroblast migration into the scaffold. On transmission electron microscopy, the basement membrane was irregular but present and adhesion complexes were noted. Conclusion: Biosynthetic corneal implantation is well tolerated in dogs, and the collagen-polymer hybrid construct holds promise for clinical application in animals and humans.
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| 5. |
- Bourghardt Peebo, Beatrice, et al.
(författare)
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Transient Anterior Corneal Deposits in a Human Immunodeficiency Virus-Positive Patient
- 2010
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Ingår i: CORNEA. - : Lippincott Williams and Wilkins. - 0277-3740. ; 29:11, s. 1323-1327
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To report findings of pigmented anterior corneal deposits in a human immunodeficiency virus-positive patient. Methods: Case report. A 49-year-old human immunodeficiency virus-positive patient was examined after the appearance of pigmented corneal deposits. Slit-lamp biomicroscopy, fundus photography, and laser-scanning in vivo confocal microscopy were performed to visually document the ocular condition. Results: The patient had a history of Mycobacterium avium infection and was suspected to have recovery uveitis from a cytomegalovirus infection. Small, rounded, light brown-colored deposits were distributed across the anterior cornea from limbus to limbus, bilaterally. In vivo confocal microscopy revealed the deposits to be confined to the basal epithelium and Bowman layer, whereas the posterior stroma, Descemet membrane, and the endothelium appeared normal. Systemic steroid treatment was administered, and 2 weeks later, the deposits had vanished on slit-lamp examination, whereas remnants were observed at the microscopic level. Conclusions: The deposits were unusual for their anterior corneal location and pancorneal distribution. The response to systemic steroid treatment remains unexplained and illustrates the complexity of the underlying conditions, their treatment, and the associated pathways of ocular manifestation.
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| 6. |
- Claesson, Margareta, et al.
(författare)
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Validation of Catquest-9SF-A Visual Disability Instrument to Evaluate Patient Function after Corneal Transplantation
- 2017
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Ingår i: Cornea. - 0277-3740 .- 1536-4798. ; 36:9, s. 1083-1088
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Catquest-9SF is a 9-item visual disability questionnaire developed for evaluating patient-reported outcome measures after cataract surgery. The aim of this study was to use Rasch analysis to determine the responsiveness of Catquest-9SF for corneal transplant patients. Methods: Patients who underwent corneal transplantation primarily to improve vision were included. One group (n = 199) completed the Catquest-9SF questionnaire before corneal transplantation and a second independent group (n = 199) completed the questionnaire 2 years after surgery. All patients were recorded in the Swedish Cornea Registry, which provided clinical and demographic data for the study. Winsteps software v.3.91.0 (Winsteps.com, Beaverton, OR) was used to assess the fit of the Catquest-9SF data to the Rasch model. Results: Rasch analysis showed that Catquest-9SF applied to corneal transplant patients was unidimensional (infit range, 0.73-1.32; outfit range, 0.81-1.35), and therefore, measured a single underlying construct (visual disability). The Rasch model explained 68.5% of raw variance. The response categories of the 9-item questionnaire were ordered, and the category thresholds were well defined. Item difficulty matched the level of patients' ability (0.36 logit difference between the means). Precision in terms of person separation (3.09) and person reliability (0.91) was good. Differential item functioning was notable for only 1 item (satisfaction with vision), which had a differential item functioning contrast of 1.08 logit. Conclusions: Rasch analysis showed that Catquest-9SF is a valid instrument for measuring visual disability in patients who have undergone corneal transplantation primarily to improve vision.
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| 9. |
- Griffith, May, et al.
(författare)
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Artificial human corneas - Scaffolds for transplantation and host regeneration
- 2002
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Ingår i: Cornea. - : Lippincott, Williams andamp; Wilkins. - 0277-3740 .- 1536-4798. ; 21:7, s. S54-S61
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To review the development of artificial corneas (prostheses and tissue equivalents) for transplantation, and to provide recent updates on our tissue-engineered replacement corneas. Methods. Modified natural polymers and synthetic polymers were screened for their potential to replace damaged portions of the human cornea or the entire corneal thickness. These polymers, combined with cells derived from each of the three main corneal layers or stem cells, were used to develop artificial corneas. Functional testing was performed in vitro. Trials of biocompatibility and immune and inflammatory reactions were performed by implanting the most promising polymers into rabbit corneas. Results. Collagen-based biopolymers, combined with synthetic crosslinkers or copolymers, formed effective scaffolds for developing prototype artificial corneas that could be used as tissue replacements in the future. We have previously developed an artificial cornea that mimicked key morphologic and functional properties of the human cornea. The addition of synthetic polymers increased its toughness as it retained transparency and low light scattering, making the matrix scaffold more suitable for transplantation. These new composites were implanted into rabbits without causing any acute inflammation or immune response. We have also fabricated full-thickness composites that can be fully sutured. However, the long-term effects of these artificial corneas need to be evaluated. Conclusions. Novel tissue-engineered corneas that comprise composites of natural and synthetic biopolymers together with corneal cell lines or stem cells will, in the future, replace portions of the cornea that are damaged. Our results provide a basis for the development of both implantable temporary and permanent corneal replacements.
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| 10. |
- Khodaparast, Mehdi, et al.
(författare)
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Sutureless Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty Using a Bioengineered Cornea as a Viable Alternative to Human Donor Transplantation for Superficial Corneal Opacities
- 2020
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Ingår i: Cornea. - : LIPPINCOTT WILLIAMS & WILKINS. - 0277-3740 .- 1536-4798. ; 39:9, s. 1184-1189
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the safety and efficacy of a bioengineered corneal implant using femtosecond laser-assisted anterior lamellar keratoplasty for superficial corneal opacities. Methods: Six eyes of 6 consecutive patients with superficial corneal stromal opacities involving <220 mu m owing to various pathologies were included in the study. Preoperatively, all patients underwent anterior segment optical coherence tomography (Visante; Carl Zeiss Meditec AG) to evaluate the depth of the corneal opacity. All patients underwent sutureless femtosecond laser-assisted anterior lamellar keratoplasty using a bioengineered collagen corneal implant (linkcor). Visual indices, refraction, and keratometry were evaluated preoperatively and 12 months postoperatively. Results: Corrected distance visual acuity improved significantly in all patients (P= 0.02). A significant decrease was seen in refractive astigmatism postoperatively (P= 0.04). Flat keratometry reduced significantly 12 months after the intervention (P= 0.04). No intraoperative or early postoperative complications were noticed. All implants were fully covered by healthy epithelium within a month after the surgery and remained clear at follow-up visits. The results of this procedure remained stable throughout the follow-up period. In 1 patient, mild inferior collagen melting and epithelial defect formation occurred at 1-year follow-up. Despite frequent topical corticosteroid therapy the melting progressed, the collagen tissue was removed and the patient was treated accordingly with good visual outcomes. Conclusions: Femtosecond laser-assisted anterior lamellar keratoplasty with bioengineered corneal (linkcor) implantation is an effective treatment for improving vision quality in anterior stromal opacities. This procedure reduces the need for human donor tissue and avoids human donor-related and suturing complications.
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