Publications by authors named "Jose de la Cruz"

69 Publications

Novel Graphene Electrode for Retinal Implants: An Biocompatibility Study.

Front Neurosci 2021 4;15:615256. Epub 2021 Mar 4.

INSERM, CNRS, Institut de la Vision, Sorbonne Université, Paris, France.

Evaluating biocompatibility is a core essential step to introducing a new material as a candidate for brain-machine interfaces. Foreign body reactions often result in glial scars that can impede the performance of the interface. Having a high conductivity and large electrochemical window, graphene is a candidate material for electrical stimulation with retinal prosthesis. In this study, non-functional devices consisting of chemical vapor deposition (CVD) graphene embedded onto polyimide/SU-8 substrates were fabricated for a biocompatibility study. The devices were implanted beneath the retina of blind P23H rats. Implants were monitored by optical coherence tomography (OCT) and eye fundus which indicated a high stability up to 3 months before histology studies were done. Microglial reconstruction through confocal imaging illustrates that the presence of graphene on polyimide reduced the number of microglial cells in the retina compared to polyimide alone, thereby indicating a high biocompatibility. This study highlights an interesting approach to assess material biocompatibility in a tissue model of central nervous system, the retina, which is easily accessed optically and surgically.
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http://dx.doi.org/10.3389/fnins.2021.615256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969870PMC
March 2021

Predictive factors of Boston Type I Keratoprosthesis outcomes: A long-term analysis.

Ocul Surf 2020 10 21;18(4):613-619. Epub 2020 Jul 21.

University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences, 1855 W Taylor St, Suite 1.145 (MC 648), Chicago, IL, 60612, USA. Electronic address:

Purpose: To study the long-term visual- and device retention-related outcomes and complications of the Boston Type I Keratoprosthesis (KPro).

Methods: Single-center, retrospective cohort study of all patients undergoing KPro implantation from February 2007 to April 2014 with at least 5 years of follow-up.

Results: 68 eyes from 65 patients underwent KPro implantation during the study period. At 5 and 10 years, the probability of maintaining or improving visual acuity (VA) was 75.0% and 66.7%, respectively, and the probability of KPro retention was 89.2% and 89.2%, respectively. Initial device retention rate at 10 years was significantly lower in those with underlying ocular surface disease (46.8% [30.6-63.2] vs 75.8% [61.0-90.7], P = 0.03), while other baseline characteristics showed no significant association. Final VA was more likely to be stable or improved in patients with fewer failed grafts (2 [1-6] vs 3 [1-6], P < 0.01), and a final VA of 20/200 or better was more likely in primary KPro eyes (44.8% [26.7-62.9] vs 19.4% [6.5-32.3], P = 0.03). Combined KPro-vitrectomy eyes were more likely to have stable or improved final VA than non-vitrectomy eyes (88.5% [76.2-100.0] vs 64.1% [49.1-79.1], P = 0.04). All complications had increasing incidence beyond 5 years; in particular, corneal melt, surgical glaucoma interventions, and endophthalmitis tended to have late presentations, with 79.0%, 78.6%, and 88.9% of these complications occurring beyond one year, respectively.

Conclusions: KPro devices show favorable long-term visual and retention outcomes in select patients. Careful long-term, multidisciplinary follow-up is warranted to address potential complications.
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http://dx.doi.org/10.1016/j.jtos.2020.07.012DOI Listing
October 2020

New Metrics to Assess Type 2 Diabetes After Bariatric Surgery: The "Time-Within-Remission Range".

J Clin Med 2020 Apr 9;9(4). Epub 2020 Apr 9.

Hospital Universitario Reina Sofia, 14004 Córdoba, Spain.

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the "time-within-remission range" as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 ± 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, "time-within-remission range" and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 ± 9.2 years old, body mass index (BMI) 46.3 ± 6.9 kg/m) underwent primary bariatric procedures. "Time-within-remission range" were 83.3% (33.3-91.6) after gastric bypass, 68.7% (7.1-87.5) after sleeve gastrectomy and 90% (83.3-92.8) after malabsorptive techniques ( < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the "time-within-remission range". The association of bariatric techniques with "time-within-remission range", using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34-5.84), < 0.001 for malabsorptive techniques and OR 0.55 (0.40-0.75), < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The "time-within-remission range" unveils a superiority of gastric bypass compared to sleeve gastrectomy.
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http://dx.doi.org/10.3390/jcm9041070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230819PMC
April 2020

Distortion-Free Sensing of Neural Activity Using Graphene Transistors.

Small 2020 04 18;16(16):e1906640. Epub 2020 Mar 18.

Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Bellaterra, Barcelona, 08193, Spain.

Graphene solution-gated field-effect transistors (g-SGFETs) are promising sensing devices to transduce electrochemical potential signals in an electrolyte bath. However, distortion mechanisms in g-SGFET, which can affect signals of large amplitude or high frequency, have not been evaluated. Here, a detailed characterization and modeling of the harmonic distortion and non-ideal frequency response in g-SGFETs is presented. This accurate description of the input-output relation of the g-SGFETs allows to define the voltage- and frequency-dependent transfer functions, which can be used to correct distortions in the transduced signals. The effect of signal distortion and its subsequent calibration are shown for different types of electrophysiological signals, spanning from large amplitude and low frequency cortical spreading depression events to low amplitude and high frequency action potentials. The thorough description of the distortion mechanisms presented in this article demonstrates that g-SGFETs can be used as distortion-free signal transducers not only for neural sensing, but also for a broader range of applications in which g-SGFET sensors are used.
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http://dx.doi.org/10.1002/smll.201906640DOI Listing
April 2020

Direct and Indirect Flap Measurements in Femtosecond Laser-Assisted In Situ Keratomileusis.

Cornea 2019 Mar;38(3):297-303

Department of Ophthalmology and Visual Sciences, Illinois Eye & Ear Infirmary, University of Illinois at Chicago, Chicago, IL.

Purpose: To compare direct and indirect LASIK flap thickness measurements using ultrasound and Scheimpflug technology.

Methods: Eighty-two eyes treated with laser-assisted in situ keratomileusis refractive surgery using a femtosecond laser (IntraLase FS150) were prospectively included in the study. Flap thickness was set to 115 μm. Corneal flap thickness was measured using the direct method-ie, ultrasound pachymetry immediately after flap construction in the presence of cavitation bubbles-and indirect methods, with subtraction of intraoperative post-lift corneal thickness measured using ultrasound pachymetry (intrastroma) from preoperative central corneal thickness using ultrasound (Indirect-US) or Scheimpflug thinnest pachymetry (Indirect-Scheimpflug).

Results: Mean flap thickness was overestimated using the indirect methods, Indirect-US and Indirect-Scheimpflug (122.6 ± 24.5 μm and 128.1 ± 26.1 μm, respectively; P < 0.0060 and P < 0.0001, respectively). There were no significant correlations between the direct and indirect methods. Indirect-Scheimpflug was significantly higher (P = 0.0122) than Indirect-US. The closest average flap thickness compared with the set parameter of 115 μm was that of the direct method (115.6 ± 8.6 μm; 95% confidence interval: -1.3 to 2.5; P = 0.5163). The direct method provided the lowest SD of all groups (SD: 8.64).

Conclusions: The direct method of flap thickness measurement was the most comparable to the set parameter compared with the indirect subtraction methods. Additional studies are needed to determine which method allows for the most accurate measurement of flap thickness.
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http://dx.doi.org/10.1097/ICO.0000000000001836DOI Listing
March 2019

High-resolution mapping of infraslow cortical brain activity enabled by graphene microtransistors.

Nat Mater 2019 03 31;18(3):280-288. Epub 2018 Dec 31.

Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Esfera UAB, Bellaterra, Spain.

Recording infraslow brain signals (<0.1 Hz) with microelectrodes is severely hampered by current microelectrode materials, primarily due to limitations resulting from voltage drift and high electrode impedance. Hence, most recording systems include high-pass filters that solve saturation issues but come hand in hand with loss of physiological and pathological information. In this work, we use flexible epicortical and intracortical arrays of graphene solution-gated field-effect transistors (gSGFETs) to map cortical spreading depression in rats and demonstrate that gSGFETs are able to record, with high fidelity, infraslow signals together with signals in the typical local field potential bandwidth. The wide recording bandwidth results from the direct field-effect coupling of the active transistor, in contrast to standard passive electrodes, as well as from the electrochemical inertness of graphene. Taking advantage of such functionality, we envision broad applications of gSGFET technology for monitoring infraslow brain activity both in research and in the clinic.
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http://dx.doi.org/10.1038/s41563-018-0249-4DOI Listing
March 2019

Recognition of Fungal Keratitis in Boston Type I Keratoprosthesis: Importance of Awareness and Novel Identification of Exophiala phaeomuriformis.

Cornea 2018 May;37(5):655-657

Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL.

Purpose: To present a case of Exophiala phaeomuriformis fungal keratitis to demonstrate the heightened concern for fungal infection in patients with a keratoprosthesis and to highlight the rare involvement of Exophiala phaeomuriformis.

Methods: Case report.

Results: Exophiala phaeomuriformis was identified in a susceptible patient 7 years after Boston type I keratoprosthesis (KPro) implantation.

Conclusions: Although fungal infiltration after KPro placement does not represent a novel clinical infection, identification of the rare Exophiala species in a patient with a KPro has not been reported and provides an opportunity for reflection on fungal identification, prophylaxis, and prevention in this vulnerable patient population.
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http://dx.doi.org/10.1097/ICO.0000000000001541DOI Listing
May 2018

Assessment of Glaucomatous Damage After Boston Keratoprosthesis Implantation Based on Digital Planimetric Quantification of Visual Fields and Optic Nerve Head Imaging.

Cornea 2018 May;37(5):602-608

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL.

Purpose: To investigate glaucomatous damage in Boston keratoprosthesis type I (KPro) patients through structural analysis of the optic nerve head and digital planimetric quantification of Goldmann visual fields, a novel method of monitoring perimetric changes in KPro patients.

Methods: Records of patients undergoing KPro implantation from 2007 to 2015 at a single institution were reviewed. Parameters related to glaucoma status and KPro outcomes were analyzed.

Results: Twenty-two eyes from 21 patients met inclusion criteria, with mean follow-up of 49.4 months (range 15-90). Mean results for the following parameters before KPro implantation and at last follow-up were (pre-KPro; at last follow-up): best-corrected visual acuity (2.07; 0.70 logMAR), number of glaucoma medications (1.14; 1.05), intraocular pressure (IOP) (18.4; 18.4 mm Hg), vertical cup-to-disc ratio (C/D) (0.48; 0.50), and horizontal C/D (0.52; 0.52). IOP-lowering procedures were performed pre-KPro (5/22), concurrently with KPro (10/22), post-KPro (6/22), or never (6/22). An increase in C/D ≥0.1 and loss of V4e isopter area >30% occurred in 22.7% and 12.5%, respectively. Development of post-KPro glaucoma, progression of preexisting or post-KPro glaucoma, and no glaucoma development as evidenced by an objective assessment of structural and functional parameters were seen in 2/22 (9.1%), 7/22 (31.8%), and 6/22 (27.3%) eyes, respectively.

Conclusions: Clinicians should strive to vigilantly monitor for glaucoma despite the inherent difficulties in tonometry, optic nerve visualization and imaging, and visual field testing in KPro patients. Meticulous glaucoma surveillance with structural and functional testing combined with earlier IOP-lowering surgical intervention may result in decreased rates of glaucomatous vision loss in KPro patients.
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http://dx.doi.org/10.1097/ICO.0000000000001544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878109PMC
May 2018

Five year outcomes of Boston type I keratoprosthesis as primary versus secondary penetrating corneal procedure in a matched case control study.

PLoS One 2018 6;13(2):e0192381. Epub 2018 Feb 6.

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States of America.

Despite improved retention and reduced complication rates paving the way for the current expansion of applications and surge in prevalence for the Boston type I Keratoprosthesis (KPro), the most frequent indication for its implantation today remains prior graft failure. The purpose of this study is to evaluate the long-term outcomes of primary KPro and compare to secondary implantation in a matched cohort study. This study included patients who underwent KPro implantation in a single center by two surgeons between July 2008 and October 2014. All eyes with KPro implantation as the primary procedure with a minimum follow up of 12 months were matched with eyes with same preoperative diagnoses that underwent secondary KPro implantation. Main outcomes included visual acuity and device retention. A total of 56 eyes were included with 28 eyes in each group. Mean follow up was 5.0 years for both groups. Twenty-nine percent (8) of the eyes in the primary group had a diagnosis of chemical or thermal injuries, 25% (7) aniridia, 18% (5) autoimmune disease, 4% (1) infectious keratitis/neurotrophic cornea, 7% (2) gelatinous corneal dystrophy, 7% (2) ectrodactyly ectodermal dysplasia/limbal stem cell deficiency, and 11% (3) uveitis/hypotony. Sixty-one percent (17) of the eyes in the primary group and 39% (11) in the secondary group maintained a final best-corrected visual acuity of 20/200 or better at a mean follow up of 5.0 years; the probability of maintaining best-corrected vision is 0.83 and 0.49 for primary and secondary groups at 5.0 years (p = 0.02). There is no statistically significant difference between groups in device retention (p = 0.22) or postoperative complication rates (p >0.05). This study demonstrates that Boston KPro implantation may be successful as a primary procedure in patients at high risk of failure with traditional penetrating keratoplasty. The device has a good long-term retention rate and visual outcomes are promising however a larger study is needed for more definitive results.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192381PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800684PMC
April 2018

Angiogenesis and lymphangiogenesis in corneal transplantation-A review.

Surv Ophthalmol 2018 Jul - Aug;63(4):453-479. Epub 2017 Dec 27.

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA. Electronic address:

Corneal transplantation has been proven effective for returning the gift of sight to those affected by corneal disorders such as opacity, injury, and infections that are a leading cause of blindness. Immune privilege plays an important role in the success of corneal transplantation procedures; however, immune rejection reactions do occur, and they, in conjunction with a shortage of corneal donor tissue, continue to pose major challenges. Corneal immune privilege is important to the success of corneal transplantation and closely related to the avascular nature of the cornea. Corneal avascularity may be disrupted by the processes of angiogenesis and lymphangiogenesis, and for this reason, these phenomena have been a focus of research in recent years. Through this research, therapies addressing certain rejection reactions related to angiogenesis have been developed and implemented. Corneal donor tissue shortages also have been addressed by the development of new materials to replace the human donor cornea. These advancements, along with other improvements in the corneal transplantation procedure, have contributed to an improved success rate for corneal transplantation. We summarize recent developments and improvements in corneal transplantation, including the current understanding of angiogenesis mechanisms, the anti-angiogenic and anti-lymphangiogenic factors identified to date, and the new materials being used. Additionally, we discuss future directions for research in corneal transplantation.
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http://dx.doi.org/10.1016/j.survophthal.2017.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003844PMC
September 2018

Neuroprotective Effect of Hydroxytyrosol in Experimental Diabetic Retinopathy: Relationship with Cardiovascular Biomarkers.

J Agric Food Chem 2018 Jan 10;66(3):637-644. Epub 2018 Jan 10.

Departmento de Farmacología, Facultad de Medicina, Instituto de Investigación Biomédica (IBIMA), Universidad de Málaga , 29016 Málaga, Spain.

The aim of the study was to test the neuroprotective effect of hydroxytyrosol (HT) on experimental diabetic retinopathy. Animals were divided in four groups: (1) control nondiabetic rats, (2) streptozotocin-diabetic rats (DR), (3) DR treated with 1 mg/kg/day p.o. HT, and (4) DR treated with 5 mg/kg/day p.o. HT. Treatment with HT was started 7 days before inducing diabetes and was maintained for 2 months. In the DR group, total area occupied by extracellular matrix was increased, area occupied by retinal cells was decreased; both returned to near-control values in DR rats treated with HT. The number of retinal ganglion cells in DR was significantly lower (44%) than in the control group, and this decrease was smaller after HT treatment (34% and 9.1%). Linear regression analysis showed that prostacyclin, platelet aggregation, peroxynitrites, and the dose of 5 mg/kg/day HT significantly influenced retinal ganglion cell count. In conclusion, HT exerted a neuroprotective effect on diabetic retinopathy, and this effect correlated significantly with changes in some cardiovascular biomarkers.
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http://dx.doi.org/10.1021/acs.jafc.7b05063DOI Listing
January 2018

Retroprosthetic Membrane Formation in Boston Keratoprosthesis: A Case-Control-Matched Comparison of Titanium Versus PMMA Backplate.

Cornea 2018 Feb;37(2):145-150

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL.

Purpose: Retroprosthetic membrane (RPM) formation is the most common complication after Boston type 1 keratoprosthesis (KPro) implantation. It affects visual acuity and can predispose to corneal melt. Two KPro backplate materials are available: titanium and polymethyl methacrylate (PMMA). This study investigates the influence of the KPro backplate material on visually significant RPM formation.

Methods: A retrospective case-control-matched study involving 40 patients; 20 eyes implanted with a titanium backplate KPro were case-matched with 20 eyes implanted with a PMMA backplate KPro between 2007 and 2015 with 1-year minimum follow-up.

Results: The mean follow-up duration was 28.1 ± 8.9 and 53.6 ± 24.3 months in the titanium and PMMA groups, respectively. At 12 months postoperatively, 7 eyes with titanium and 6 eyes with PMMA backplates developed a visually significant RPM. By the end of the study, a total of 11 eyes with titanium and 9 eyes with PMMA KPros developed a visually significant RPM. There was no statistically significant difference between both groups. Three of 11 eyes with titanium KPros that had a visually significant RPM required surgical membranectomy, whereas all eyes with PMMA KPros were successfully treated with the yttrium-aluminum-garnet laser. Recurrence of RPMs was found in 7/11 eyes in the titanium group and 2/9 eyes in the PMMA group with no statistical significance.

Conclusions: Titanium backplate KPros do not significantly reduce RPM formation compared with PMMA backplate KPros in a case-control-matched setting. A larger prospective study is warranted to evaluate comparative long-term performance and guide newer designs.
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http://dx.doi.org/10.1097/ICO.0000000000001462DOI Listing
February 2018

Effects of hydroxytyrosol on cardiovascular biomarkers in experimental diabetes mellitus.

J Nutr Biochem 2016 11 26;37:94-100. Epub 2016 Aug 26.

Departmento de Farmacología, Facultad de Medicina, Instituto de Investigación Biomédica (IBIMA), Universidad de Málaga. Electronic address:

The aim of this study was to assess the influence of hydroxytyrosol (HT) on cardiovascular biomarkers and morphometric parameters of the arterial wall in streptozotocin-diabetic rats. Seven groups of rats (N=10 per group) were studied for 2 months: nondiabetic rats (NDR), diabetic rats treated with saline (DR) and DR treated with HT (0.5, 1, 2.5, 5 and 10 mg kg day p.o.). DR had higher platelet aggregation values, higher thromboxane B, plasma lipid peroxidation, 3-nitrotyrosine, oxidized LDL (oxLDL), myeloperoxidase, vascular cell adhesion molecule 1 (VCAM-1) and interleukin-1β (IL-1β) concentrations, and lower aortic 6-keto-prostaglandin F and nitric oxide production than NDR. Aortic wall area and smooth muscle cell count were also higher in DR than in NDR. HT significantly reduced both oxidative and nitrosative stress, oxLDL concentration, VCAM-1 and inflammatory mediators, platelet aggregation and thromboxane B production. Morphometric values in the aortic wall were reduced to values near those in NDR. In conclusion, HT influenced the major biochemical processes leading to diabetic vasculopathy, and reduced cell proliferation in the vascular wall in this experimental model.
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http://dx.doi.org/10.1016/j.jnutbio.2016.07.015DOI Listing
November 2016

Biofilm Formation on Bandage Contact Lenses Worn by Patients with the Boston Type 1 Keratoprosthesis: A Pilot Comparison Study of Prophylactic Topical Vancomycin 15 mg/mL and Linezolid 0.2.

Eye Contact Lens 2018 Sep;44 Suppl 1:S106-S109

Department of Ophthalmology & Visual Sciences (A.V.F., S.J., Z.H., E.Y.T., J.d.l.C., M.S.C.), University of Illinois at Chicago, Chicago, IL; and Department of Ophthalmology & Visual Neurosciences (J.H.H.), University of Minnesota, Minneapolis, MN.

Objectives: To determine the rate of biofilm formation on bandage contact lenses worn by patients with the Boston type 1 keratoprosthesis (K-Pro) while on prophylactic topical vancomycin versus linezolid.

Methods: Patients wearing a bandage contact lens (BCL) with a K-Pro were eligible for enrollment. After irrigation of the ocular surface with 5% povidone-iodine solution, each patient was placed on either topical vancomycin 15 mg/mL or linezolid 0.2% BID for one month. At the one-month visit, the BCL was collected and stored in fixative solution. Standard photographs were taken of each lens at high magnification using scanning electron microscopy (SEM), which were subsequently analyzed for evidence of biofilm.

Results: Nineteen contact lenses were obtained from 12 K-Pro patients at the Illinois Eye and Ear Infirmary. Zero of eight (0%; 95% CI=0 to 37%) contact lenses from patients treated with topical vancomycin, and 1 of 11 (9%; 95% CI=0 to 41%; P-value=1.00) contact lenses from patients treated with topical linezolid were found to have biofilm formation at one month as detected by SEM. None of the patients developed a clinically significant infection while on either prophylactic vancomycin or linezolid during the study period.

Conclusions: Overall, the rate of biofilm formation as detected by SEM on the surface of bandage contact lenses was low. These results suggest that vancomycin and linezolid are both relatively effective in reducing biofilm-forming bacterial growth at one month. Accordingly, linezolid may be an effective alternative to vancomycin in patients with allergy or intolerance. However, further investigation is required to develop evidence-based antibiotic prophylaxis regimens.
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http://dx.doi.org/10.1097/ICL.0000000000000337DOI Listing
September 2018

Neuroprotective Effect of Hydroxytyrosol in Experimental Diabetes Mellitus.

J Agric Food Chem 2017 Jun 25;65(22):4378-4383. Epub 2017 May 25.

Departmento de Farmacologı́a, Facultad de Medicina, Instituto de Investigación Biomédica (IBIMA), Universidad de Málaga , Campus de Teatinos s/n, 29071Málaga, Spain.

The aim of the study was to analyze the possible neuroprotective effect of hydroxytyrosol (HT) in diabetic animals in a model of hypoxia-reoxygenation. Rats (10 animals/group) were distributed in five groups: nondiabetic rats, control diabetic rats (DR), and DR rats treated for 2 months with 1, 5, or 10 mg/kg/day po HT. At the end of follow-up, an experimental model of hypoxia-reoxygenation in brain slices was tested. The DR group showed increased cell death, oxidative and nitrosative stress, and an increase in brain inflammatory mediators. These alterations were significantly greater in DR than in normoglycemic animals. HT significantly reduced oxidative (38.5-52.4% lipid peroxidation) and nitrosative stress (48.0-51.0% nitric oxide and 43.9-75.2% peroxynitrite concentration) and brain inflammatory mediators (18.6-40.6% prostaglandin E and 17.0-65.0% interleukin 1β concentration). Cell death was reduced by 25.9, 37.5, and 41.0% after the administration of 1, 5, or 10 mg/kg/day. The administration of HT in rats with experimental diabetes thus had a neuroprotective effect.
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http://dx.doi.org/10.1021/acs.jafc.6b02945DOI Listing
June 2017

Synthesis and Antioxidant Activity of Alkyl Nitroderivatives of Hydroxytyrosol.

Molecules 2016 May 18;21(5). Epub 2016 May 18.

Department of Organic and Pharmaceutical Chemistry, Faculty of Pharmacy, University of Seville, 41012 Seville, Spain.

A series of alkyl nitrohydroxytyrosyl ether derivatives has been synthesized from free hydroxytyrosol (HT), the natural olive oil phenol, in order to increase the assortment of compounds with potential neuroprotective activity in Parkinson's disease. In this work, the antioxidant activity of these novel compounds has been evaluated using Ferric Reducing Antioxidant Power (FRAP), 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS), and Oxygen Radical Scavenging Capacity (ORAC) assays compared to that of nitrohydroxytyrosol (NO₂HT) and free HT. New compounds showed variable antioxidant activity depending on the alkyl side chain length; compounds with short chains (2-4 carbon atoms) maintained or even improved the antioxidant activity compared to NO₂HT and/or HT, whereas those with longer side chains (6-8 carbon atoms) showed lower activity than NO₂HT but higher than HT.
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http://dx.doi.org/10.3390/molecules21050656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6272824PMC
May 2016

Image-guided femtosecond laser-assisted cataract surgery in Peters anomaly type 2.

J Cataract Refract Surg 2015 Nov;41(11):2353-7

From the Department of Ophthalmology and Visual Sciences (Hou, Crispim, Cortina, de la Cruz), University of Illinois Eye and Ear Infirmary, Chicago, Illinois, and the Department of Ophthalmology and Visual Neurosciences (Hou), University of Minnesota, Minneapolis, Minnesota, USA; the Department of Ophthalmology and Visual Sciences (Crispim), Federal University of Sao Paulo, Sao Paulo, Brazil.

Unlabelled: We describe a technique for image-guided femtosecond laser-assisted cataract surgery in a case of Peters anomaly type 2. The femtosecond laser technology enabled reliable construction of a complete capsulotomy despite central corneal opacification and a tented anterior capsule. Use of an image-guided femtosecond laser for cataract extraction in Peters anomaly type 2 is a safe method for removing these complex cataracts while preserving capsular and corneal integrity.

Financial Disclosure: Dr. De la Cruz is a consultant to Alcon Surgical, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
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http://dx.doi.org/10.1016/j.jcrs.2015.10.045DOI Listing
November 2015

Scanning Electron Microscopic Analysis of Biofilm Formation in Explanted Human Boston Type I Keratoprostheses.

Cornea 2016 Jan;35(1):25-9

*Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL; †Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; ‡Department of Ophthalmology, University of Minnesota, Minneapolis, MN; §Microbiology and Molecular Biology and Ophthalmology, Tufts University School of Medicine, Boston, MA; ¶Infectious Diseases, Mount Auburn Hospital, Cambridge, MA.

Purpose: To describe the morphological distribution of host tissue and microbial biofilms on the intraocular surfaces of Boston type I keratoprostheses (KPros) explanted because of corneal melt.

Methods: Retrospective study of scanning electron microscopy (SEM) images from 4 explanted Boston type I KPros composed of polymethylmethacrylate and titanium. SEM images of KPro-associated ocular surfaces were reviewed for the presence of inflammatory cells, microbes, and/or biofilm formation. One sterile type I KPro was also imaged to serve as a (device only) control.

Results: All 4 KPros were explanted because of culture-negative, clinically "sterile" donor corneal melt with impending KPro extrusion. In all cases, the rough, irregular surfaces of the device harbored more adherent corneal epithelium and stromacytes, inflammatory cells, and bacteria than the smooth, polished surface of the KPro optic. Two KPros showed not only evidence of prior bacterial colonization but marked biofilm formation.

Conclusions: SEM images of explanted KPros explanted for "sterile" corneal melt demonstrated evidence of biofilm formation despite negative donor corneal cultures and the absence of clinical suspicion for infection. These results suggest that "sterile" corneal melt may be due to inflammatory host responses to low microbial burdens as seen in biofilms and/or released antigens after antibiotic-induced lysis. There was increased adherence of host tissue cells and microbial biofilms on the nonpolished surfaces of the KPro. Polishing the intraocular polymethylmethacrylate and titanium KPro surfaces may decrease microbial adhesion and biofilm formation in human subjects with KPros, but what impact this will have on rates of postoperative endophthalmitis is unknown.
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http://dx.doi.org/10.1097/ICO.0000000000000674DOI Listing
January 2016

Randomized clinical trial of the efficacy and safety of insulin glargine vs. NPH insulin as basal insulin for the treatment of glucocorticoid induced hyperglycemia using continuous glucose monitoring in hospitalized patients with type 2 diabetes and respiratory disease.

Diabetes Res Clin Pract 2015 Nov 30;110(2):158-65. Epub 2015 Sep 30.

Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.

Aims: To investigate the clinical efficacy and safety of insulin glargine compared with NPH insulin as basal insulin for the management of corticosteroid-induced hyperglycemia in hospitalized people with type 2 diabetes (T2DM) and respiratory disease.

Materials And Methods: Randomized, two-arm parallel group, clinical trial undertaken from February 2011 to November 2012 on the pneumology ward of the Hospital Regional Universitario de Málaga (Spain), involving 53 participants with T2DM treated with medium/high doses of intermediate-acting corticosteroids. Participants were randomly assigned to receive one single dose of insulin glargine or NPH insulin in three equally divided doses before each meal as basal insulin within a basal-bolus insulin protocol. The intervention lasted six days or until discharge if earlier.

Results: No significant differences were seen between groups during the study in mean blood glucose (11.43±3.44 mmol/l in glargine vs. 11.88±2.94 mmol/l in NPH, p=0.624), and measures of glucose variability (standard deviation 3.27±1.16 mmol/l vs. 3.61±0.99 mmol/l, p=0.273; coefficient of variation 1.55±0.33 mmol/l vs. 1.72±0.39 mmol/l, p=0.200). Results from CGM were concordant with those obtained with capillary blood glucose reading. The length of hospital stay was also similar between groups (8.2±2.8 days vs. 9.8±3.4 days, p=0.166) There was a non significant trend for lower episodes of mild (4 vs. 8, p=0.351) and severe hypoglycemia (0 vs. 3, p=0.13) in the glargine group.

Conclusions: The results of this study showed that insulin glargine and NPH insulin are equally effective in a basal-bolus insulin protocol to treat glucocorticoid-induced hyperglycemia in people with T2DM on a pneumology ward.
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http://dx.doi.org/10.1016/j.diabres.2015.09.015DOI Listing
November 2015

Bacteria Colonizing the Ocular Surface in Eyes With Boston Type 1 Keratoprosthesis: Analysis of Biofilm-Forming Capability and Vancomycin Tolerance.

Invest Ophthalmol Vis Sci 2015 Jul;56(8):4689-96

Department of Ophthalmology and Visual Sciences University of Illinois at Chicago, Chicago, Illinois, United States.

Purpose: To analyze the bacterial microbiota colonizing the ocular surface of patients with Boston type 1 keratoprostheses (K-Pros) for antibacterial resistance patterns and capacity to form biofilms.

Methods: Twenty-seven eyes with a Boston type 1 K-Pro and 16 fellow control eyes from 26 patients were enrolled. The surface of the K-Pro optic and/or the inferior conjunctival fornix was swabbed and plated separately on culture media. Positive cultures were processed to assess for biofilm-forming capability. Microtiter plate adherence assay and polymerase chain reaction for ica and atlE genes were used. An in vitro assay of vancomycin tolerance was performed on isolated strains and compared to standard controls with and without biofilm-forming capability.

Results: Eighty-five percent of K-Pro eyes and 69% of control eyes had positive cultures (P = 0.20). All Gram-positive strains exhibited susceptibility to vancomycin by standard testing. Biofilm-forming bacterial isolates were detected in 57.7% of K-Pro eyes and 53.3% of control eyes. A vancomycin tolerance assay showed that the antibiotic susceptibility of coagulase-negative staphylococcus (CNS) within biofilms was significant in only three of five biofilm-forming strains (P < 0.05). In all strains, bacterial cells in planktonic form were more susceptible to vancomycin than in biofilm form (P < 0.001).

Conclusions: Coagulase-negative staphylococcus can be isolated from K-Pro surfaces despite the use of vancomycin prophylaxis. In this study, the majority of isolated strains had biofilm-forming capability. In vitro vancomycin tolerance assays suggest that biofilm formation decreases susceptibility to vancomycin. This may contribute to higher rates of infectious complications observed in these patients.
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http://dx.doi.org/10.1167/iovs.15-17101DOI Listing
July 2015

Differences in the Neuroprotective Effect of Orally Administered Virgin Olive Oil (Olea europaea) Polyphenols Tyrosol and Hydroxytyrosol in Rats.

J Agric Food Chem 2015 Jul 19;63(25):5957-63. Epub 2015 Jun 19.

†Laboratorio de Investigaciones Antitrombóticas e Isquemia Tisular (LIAIT), Department of Pharmacology and Therapeutics, School of Medicine, University of Malaga, Malaga, Spain.

The neuroprotective effect of virgin olive oil (VOO) polyphenols has been related to their antioxidant effect. The main objective was to analyze how tyrosol and hydroxytyrosol contribute to the antioxidant and neuroprotective effects of VOO in a model of hypoxia-reoxygenation in rat brain slices. Rats were treated per os (po) (10 or 20 mg/kg/day) with hydroxytyrosol ethyl ether (HTEE), tyrosol ethyl ether (TEE), or 3,4-di-o-methylidene-hydroxytyrosol ethyl ether (MHTEE), used as a negative control for antioxidant effects. Lipid peroxidation was inhibited with HTEE, TEE, and MHTEE (from 5.0 ± 1.5 to 2.6 ± 1.5, 4.5 ± 1.5, and 4.8 ± 1.5 nmol/mg protein, respectively). However, all three compounds had similar neuroprotective effects: from 2.8 ± 0.07 to 1.8 ± 0.02 arbitrary units for HTEE, 1.4 ± 0.09 arbitrary units for TEE, and 1.3 ± 0.2 arbitrary units for MHTEE. All three compounds inhibited 3-nitrotyrosine production (from 3.7 ± 0.3 to 1.2 ± 0.03 nmol/0.1 g tissue for HTEE, 1.0 ± 0.2 nmol/0.1 g tissue for TEE, and 1.3 ± 0.1 nmol/0.1 g tissue for MHTEE), prostaglandin E2 production (from 55.7 ± 2.2 to 46.4 ± 1.9 pg/0.1 g tissue for HTEE, 24.7 ± 1.3 pg/0.1 g tissue for TEE, and 27.6 ± 2.6 pg/0.1 g tissue for MHTEE), whereas only HTEE inhibited IL1β production (from 35.7 ± 1.5 to 21.6 ± 0.8 pg/0.1 g tissue). Pearson correlation coefficients related neuroprotective effect with an antioxidant effect for HTEE (R = 0.72, p < 0.001), and inhibition of nitrosative stress (R = 0.78, 0.67, and 0.66 for HTEE, TEE, and MHTEE, respectively, p < 0.001) and inflammatory mediators (R = 0.72, 0.79, and 0.64 for HTEE, TEE, and MHTEE, respectively, p < 0.001) with all three compounds.
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http://dx.doi.org/10.1021/acs.jafc.5b00627DOI Listing
July 2015

Cyclotorsional and non-cyclotorsional components of eye rotation observed from sitting to supine position.

Br J Ophthalmol 2015 Jan 12;99(1):49-53. Epub 2014 Aug 12.

Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago-UIC, USA Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-UNIFESP, Brazil.

Purpose: Evaluate average cyclotorsional and non-cyclotorsional components (NCY) of eye rotation from sitting to supine, and associate average cyclotorsion to different variables.

Methods: Medical records of patients who underwent bilateral sequential laser refractive surgery were retrospectively evaluated. Recorded variables included the patient's age, refraction, automated keratometry, pupil displacement and eye rotation from sitting to supine position. Measured iris rotation (total rotation, TR) was decomposed into two components: NCY, defined as the common rotation component of each eye of the same patient, and cyclotorsional component (CY), defined as the assumed independent eye rotation for each eye in relation to the face, so that TR=NCY+CY. Cyclotorsion ratio (CR) was calculated as CR=|CY|/|TR|, and used to correlate CY with TR for each eye.

Results: Data from 310 eyes of 155 patients were evaluated. TR was +1.43° ±3.41° (-8.30° to +9.20°). Average CYs and NCYs per patient were +1.43°±2.04° (-3.15± to +7.40°) and -0.28°±2.72° (-6.85° to +7.15°), respectively. TR demonstrated that 40.6% and 8.4% of patients presented bilateral excyclotorsion and incyclotorsion, respectively. When excluding NCYs, average CYs demonstrated that 74.2% of patients presented excyclotorsion and 23.9% presented incyclotorsion. CR demonstrated that TR represented from 75% to 125% of average CY in 19.68% of the eyes. TR overestimated and underestimated average CYs above these limits in 52.26% and 28.06% of the eyes, respectively. There was no statistical association between average CYs and the different variables.

Discussion: This study demonstrates that most of the rotations previously attributed to torsional components were probably due to NCYs, such as postural misalignments. Apparently, the amplitude of cyclotorsional movements is smaller than observed in previous reports, and could not be associated with any studied variable.
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http://dx.doi.org/10.1136/bjophthalmol-2014-304975DOI Listing
January 2015

Histopathological and immunohistochemical analysis of melt-associated retroprosthetic membranes in the Boston type 1 keratoprosthesis.

JAMA Ophthalmol 2014 Sep;132(9):1133-6

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago.

Importance: Retroprosthetic membrane (RPM) formation is the most common complication associated with the Boston type 1 keratoprosthesis and has been associated with corneal melt.

Objective: To identify the histological and immunohistochemical characteristics of RPMs associated with corneal melt.

Design, Setting, And Participants: Observational histopathological case series at a tertiary eye care referral center among patients who underwent Boston type 1 keratoprosthesis explantation because of donor corneal melt at the Illinois Eye and Ear Infirmary between January 1, 2011, and January 1, 2012.

Exposures: Seven RPM specimens from 7 eyes were stained with hematoxylin-eosin, cytokeratin 7, cytokeratin AE1/3, smooth muscle actin, vimentin, and CD34. Light microscopy was used to evaluate specimens for inflammation and epithelial ingrowth. XY-karyotyping using fluorescence in situ hybridization was performed on 4 specimens with known donor-recipient sex mismatch.

Main Outcomes And Measures: Histological and immunohistochemical characteristics of RPMs.

Results: Inflammatory cells were present in 4 of 7 RPMs. In 3 of 4 sex-mismatched specimens, tissue XY-karyotyping of the RPM interphase cells was consistent with the host sex karyotype. The fourth specimen showed a mixture of recipient-type and donor-type cells.

Conclusions And Relevance: Melt-associated RPMs show variable degrees of inflammation. Most membranes seem to originate from a proliferation of host cells, but donor tissue may contribute in some cases.
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http://dx.doi.org/10.1001/jamaophthalmol.2014.1959DOI Listing
September 2014

Outcomes of pars plana glaucoma drainage implant in Boston type 1 keratoprosthesis surgery.

J Glaucoma 2014 Jan;23(1):e39-44

Illinois Eye & Ear Infirmary, University of Illinois at Chicago School of Medicine, Chicago, IL.

Purpose: Glaucoma drainage implantation in conjunction with Boston Type 1 Keratoprosthesis placement is a surgical option in controlling postoperative glaucoma. The purpose of this study is to report outcomes of combined pars plana vitrectomy and glaucoma drainage implantation with corneal patch graft in Boston Type 1 Keratoprosthesis patients.

Patients And Methods: A retrospective review of patients who underwent pars plana glaucoma drainage implantation in combination with Boston Type 1 Keratoprosthesis was performed. Preoperative and postoperative parameters collected and analyzed included: visual acuity, intraocular pressure, number of glaucoma medications to achieve intraocular pressure control, bandage contact lens fit, and postoperative complications.

Results: Twenty eyes of 20 patients were identified; 95% had preoperative diagnosis of glaucoma, utilizing on an average 2.5 medications with an average intraocular pressure of 19.8 mm Hg (±6.3 mm Hg; range, 9 to 32.8 mm Hg). After placement of the pars plana glaucoma drainage implant, an average intraocular pressure of 19 mm Hg (±7.0 mm Hg; range, 8 to 30 mm Hg) by scleral pneumotonometry was achieved and 85% were deemed to have normal pressures by digital palpation. An average of 2.1 intraocular pressure-lowering medications were required on last follow-up. Average follow-up was 31.6 months (±17.4 mo; range, 12.3 to 71.6 mo). Two eyes required glaucoma drainage implant explantation: one eye due to endophthalmitis from a nonhealing corneal ulcer and the other eye due to corneal melt. None of our patients experienced conjunctival erosion over a pars plana positioned glaucoma drainage implant or tube.

Conclusions: For the long-term management of glaucoma in keratoprosthesis patients, a posteriorly placed pars plana glaucoma drainage implant with corneal patch graft in conjunction with keratoprosthesis has a low risk of erosion and postoperative complications.
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http://dx.doi.org/10.1097/IJG.0b013e31829e55f8DOI Listing
January 2014

Successful Müller muscle-conjunctiva resection in patients with Boston keratoprosthesis type I.

Cornea 2014 Mar;33(3):240-2

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL.

Purpose: To present a case series of patients with Boston keratoprosthesis type I (KPro) who have had successful ptosis repair with Müller muscle-conjunctiva resection (MMCR).

Methods: Patients with KPros managed with MMCR for ptosis were identified. Records were examined to obtain preoperative and postoperative visual acuity, KPro viability, and eyelid measurements including margin-to-reflex distance 1 (MRD1), levator function, and lagophthalmos.

Results: Seven eyes of 6 patients with KPros and ptosis treated with MMCR were identified. Four eyes underwent a lower lid tarsal strip procedure concurrently with the MMCR to minimize the risk of exposure to the graft postoperatively. The average time between KPro surgery and ptosis surgery was 29.1 months (range, 4-79 months). Preoperatively, the average MRD1 was -2.4 mm and the average levator function was 11.3 mm. Postoperatively, all eyelids were elevated and the average MRD1 was 0.9 mm. One eye had 0.5 mm of lagophthalmos noted whereas all other eyes had no lagophthalmos. The average follow-up time was 25.9 months (range, 13-41 months). All 7 eyes maintained a viable KPro without any compromise to the conjunctiva or donor corneal tissue.

Conclusions: This retrospective case series describes 7 eyes with KPros that underwent successful MMCR without compromise to the integrity of the KPro. Because these patients are at high risk for potential complications, we recommend careful patient selection, a goal of undercorrection, and consideration of supplemental procedures to the lower eyelids to minimize complications to the KPro.
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http://dx.doi.org/10.1097/ICO.0000000000000043DOI Listing
March 2014

Role of the inhibition of oxidative stress and inflammatory mediators in the neuroprotective effects of hydroxytyrosol in rat brain slices subjected to hypoxia reoxygenation.

J Nutr Biochem 2013 Dec;24(12):2152-7

Laboratorio de Investigaciones Antitrombóticas e Isquemia Tisular (LIAIT), Department of Pharmacology and Therapeutics.

The aim of this study was to analyze the mechanism of the neuroprotective effect of hydroxytyrosol (HT) in an experimental model of hypoxia-reoxygenation in rat brain slices. After reoxygenation the increase in lactate dehydrogenase efflux was inhibited by HT in a concentration-dependent manner and dose-dependent inhibition after oral administration to rats for 7 days (1, 5 and 10 mg/kg per day). Maximum inhibition was 57.4% in vitro and 38.7% ex vivo. Hydroxytyrosol reduced oxidative stress parameters: it inhibited lipid peroxidation and increased enzymatic activities related with the glutathione system both in vitro and after oral administration to rats. The increase in prostaglandin E2 and interleukin 1β after reoxygenation were inhibited after incubation of brain slices with HT and after oral administration. The accumulation of nitric oxide in brain slices was reduced in a concentration-dependent manner. In conclusion, HT exerts a neuroprotective effect in a model of hypoxia-reoxygenation in rat brain slices, both in vitro and after 7 days of oral administration to rats. HT exerts an antioxidant activity and lowered some inflammatory markers in this model.
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http://dx.doi.org/10.1016/j.jnutbio.2013.08.007DOI Listing
December 2013

Serial Analysis of Anterior Chamber Depth and Angle Status Using Anterior Segment Optical Coherence Tomography After Boston Keratoprosthesis.

Cornea 2013 Oct;32(10):1369-74

*Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and †Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.

Purpose: To analyze iris behavior and angle status using serial anterior segment optical coherence tomography (AS-OCT) after Boston keratoprosthesis (KPro).

Methods: A prospective cases series consisted of 11 eyes with implanted type 1 KPro at a tertiary care institution. The patients underwent preoperative and serial postoperative AS-OCT imaging. The main outcome measures included anterior chamber angle (ACA) at representative meridians (0 degrees, 45 degrees, 90 degrees, 135 degrees, 180 degrees, 225 degrees, 270 degrees, and 315 degrees), grading of total ACA as open (>10 degrees), shallow (≥1 degrees and ≤10 degrees) or closed (<1 degrees), preoperative anterior chamber depth (ACD), postoperative anatomical and functional ACD, and the presence of iris-back plate touch and peripheral anterior synechiae.

Results: The mean follow-up with serial AS-OCT was 13.1 months. Preoperatively, 54.5%, 27.3%, and 18.2% of the eyes had open, shallow, and closed angles, respectively. The mean change in the effective ACD decreased postoperatively by 1.61 mm. At 0 degree and 180 degree meridians, the ACA decreased by a mean change of 6.95 degrees and 8.40 degrees, with a mean change of 8.12 degrees for all meridians. Eight (72.7%) eyes had synechiae with 7.3 and 6.7 clock hours of peripheral anterior synechiae and iris-back plate touch. At the last follow-up, 7 (63.6%) eyes had considerable progression of angle closure (change in grading of total angle), and 18.2%, 36.4%, and 45.5% had open, shallow, and closed angles, respectively.

Conclusions: KPro implantation induced progressive angle closure, shallowing of the anterior chamber, and synechiae formation that is not visible on clinical examination. Serial AS-OCT plays an important role in the detection and monitoring of progressive angle closure, and clinical correlation is needed to assess the association with glaucoma development or progression.
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http://dx.doi.org/10.1097/ICO.0b013e3182a0cff5DOI Listing
October 2013

Anterior segment optical coherence tomography for the quantitative evaluation of the anterior segment following Boston keratoprosthesis.

PLoS One 2013 5;8(8):e70673. Epub 2013 Aug 5.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America.

Objective: To quantitatively evaluate the anterior segment using anterior segment optical coherence tomography (AS-OCT) following Boston keratoprosthesis type 1.

Methods: A retrospective study consisted of AS-OCT imaging at a single time point postoperatively in 52 eyes. Main outcomes measures include anatomical and functional anterior chamber depth (ACD), angle (ACA) and peripheral and proximal synechiae.

Results: The mean time point of imaging was 19.3 months postoperatively. Average anatomical and functional ACD was 2.0 and 0.21 mm respectively, and mean ACA ranged from 2.5° to 6.14° in representative meridians. An average of 8.7 clock hours of angle closure was observed in the 25 eyes in which all meridians were imaged. The majority of eyes showed peripheral (86.5%) and proximal (67.3%) synechiae.

Conclusions: AS-OCT is a useful tool for quantitative evaluation of anterior segment and angle after keratoprosthesis, which is otherwise poorly visible. The majority of eyes showed shallow ACD, extensive angle closure and synechiae formation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0070673PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734235PMC
March 2014