Eyeworld

116 | EYEWORLD | JULY 2021 C ORNEA by Liz Hillman Editorial Co-Director About the physicians Irit Bahar, MD, MHA Director Department of Ophthalmology Rabin Medical Center Petah Tikva, Israel Sophie Deng, MD, PhD Joan and Jerome Snyder Chair in Cornea Diseases Stein Eye Institute University of California, Los Angeles Los Angeles, California Gilad Litvin, MD Chief Medical Officer CorNeat Vision Ra'anana, Israel Conversations about KPro K eratoprosthesis (KPro) is not frequent- ly discussed in the greater ophthalmic community. It is a rare procedure and there is only one device approved by the FDA for use in the U.S., the Boston KPro. Since its initial FDA approval in 1992, less than 15,000 Boston KPro procedures have taken place as of 2019. 1 Keratoprosthesis is an active area of re- search and development, however, and Sophie Deng, MD, PhD, said there have been recent innovations and updates to some devices in the keratoprosthesis field as a whole. Boston KPro update and insights The Boston KPro is the most commonly refer- enced keratoprosthesis in the U.S. In general, there have not been major changes to the Boston Type I KPro within the last 5 years, Dr. Deng said. Updates from the original design that occurred prior were the option for a titanium backplate that was slightly larger than the original PMMA backplate (the latter of which is still available, and Dr. Deng uses PMMA) and a snap-on backplate design (the previous version was screw on). Boston KPro allows for a quick visual recovery and excellent visual outcome shortly after surgery, Dr. Deng said. The key for long- term success with KPro is in the postop regimen, she said. It is significantly more labor intensive than a corneal transplant, with patients on anti- inflammatories, antibiotics, antifungals, and sometimes glaucoma medications. She noted that it's now standard of care for a patient with glaucoma to have a combined Boston KPro and tube shunt procedure. Weekly follow-up continues until the cor- neal surface is re-epithelialized, Dr. Deng said. After the patient is stable, the follow-up interval is adjusted to usually every 2–4 months. Dr. Deng said ophthalmologists performing follow-up care locally for KPro patients need to be familiar with all the possible complications associated with this procedure. "We have seen patients become NLP be- cause the local ophthalmologists were not famil- iar with the risk of glaucoma. This is the leading Before and after the CorNeat KPro Source: Gilad Litvin, MD cause of loss of vision in long-term follow-up. The other is infection. The infection is devastat- ing and can blind people," she said. "The ophthalmologist needs to recognize if there is any infiltrate in the donor tissue adjacent to the KPro and any epithelial defect or anterior chamber reaction that could indicate there is infection in the cornea. If they see those signs, the patients need to be treated with more aggressive antibiotic regimen. After keratopros- thesis, the patients will be on antibiotics for the rest of their life," Dr. Deng said. "The most com- mon pathogen of infection is microbial followed by fungi. Fungal infection is more difficult to eradicate." A newcomer in the KPro field There are many players in the KPro field avail- able globally, some with more nuanced indica- tions and/or different designs and materials. Earlier this year, the CorNeat KPro (CorNeat Vision), a newcomer to the space, made head- lines. The CorNeat KPro is described on the company's website as a "patented synthetic cornea utilizing advanced cell technology to integrate artificial optics within resident ocular tissue. It is produced using nanoscale chemical

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