EyeWorld India September 2021 Issue

CORNEA EWAP SEPTEMBER 2021 47 the patients will be on antibiotics for the rest of their life,” Dr. Deng said. “The most common 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 available globally, some with more nuanced indications and/or different designs and materials. Earlier this year, the CorNeat KPro (CorNeat Vision), a newcomer to the space, made headlines. 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 engineering, which stimulates cellular growth.” The CorNeat KPro is designed to integrate under the conjunctiva. Surgically, the CorNeat KPro implantation procedure is designed to reduce the time of “open sky.” Irit Bahar, MD, MHA, who performed the first-in-human CorNeat KPro procedure in January 2021, said the surgical sophistication needed for most KPro procedures and the high rate of complications, due to the procedure or materials, motivated creation of the CorNeat KPro. Prof. Bahar said the first patient who received the CorNeat KPro has been having weekly follow-up with the results exceeding expectations thus far. Gilad Litvin, MD, creator of the CorNeat KPro, noted that the synthetic nature of the device makes timing of the procedure more flexible, compared to those reliant on donor tissue. “Once you don’t need an organic tissue, you can time the implantation at the surgeon’s and patient’s convenience,” he said. “The attachment site of the CorNeat KPro is external to the eye, thus no interference with ocular physiology occurs,” Dr. Litvin explained. The device is also designed to allow for future anterior segment procedures. “Follow-up is expected to be much simpler than previous [KPro] models. There is no need for protective contact lenses and no need for lifelong, local antibiotic treatment,” Dr. Litvin said. Dr. Deng, who said she only has hands-on experience with Boston KPro technologies, shared some thoughts on innovations like the CorNeat KPro. She said newer KPro technologies try to reduce risk of rejection with biointegratable materials, while also eliminating reliance on donor corneal tissue. “Other options are being developed to try to solve the problem of integration and stability and the need for donor tissue,” she said. Ophthalmologists’ daily work is vision preservation and restoration, but the KPro cases, Prof. Bahar said, are particularly emotional. “This process requires both physical and mental resources, which few centers in the world can afford,” she said. “The KPro surgery instills hope for restoring the patient’s vision. The patient, his family, and the medical staff treating him are all emotionally involved. When we succeed, it’s amazing and it’s a supreme feeling of fulfilling our mission as ophthalmologists, but when it does not materialize or if it gets complicated, the frustration is equally great for everyone involved.” EWAP References 1. Chodosh J. FDA approval obtained for the Boston Keratoprosthesis Type 1 Lucia Design. Boston KPro News . July 2019. 2. Klufas M, et al. Boston Keratoprosthesis (KPro). eyewiki. aao. org/Boston_Keratoprosthesis_(KPro). Accessed Mar 3, 2021. 3. Ortiz-Morales G, et al. Modified Osteo-Odonto-Keratoprosthesis. eyewiki.aao.org/Modified_Osteo- Odonto-Keratoprosthesis. Accessed Mar 3, 2021. 4. Miro Cornea UR. www.Miro-Vision.de . Accessed Mar 3, 2021. 5. Basu S, et al. LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness. Br J Ophthalmol . 2019;103:592–598. Editors’ note: Dr. Bahar, Director, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel. Prof. Deng practices at Joan and Jerome Snyder Chair in Cornea Diseases, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California. Dr. Bahar and Dr. Deng disclosed no relevant financial interests. Dr. Litvin is Chief Medical Officer, CorNeat Vision, Ra’anana, Israel, and has interests with CorNeat Vision. Different KPro devices* Boston KPro Type I (developed at Massachusetts Eye aPd Ear +Pfirmary FDA approved; indicated for patients with multiple corneal graft failures, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and more. 2 Boston KPro Type II: FDA approved; similar to Boston KPro Type I but indicated for “severe end-stage ocular surface disease desiccation.” 2 CorNeat KPro: Similar indications as the Boston KPro; no donor corneal tissue used; made of synthetic, biointegratable material. /odified Osteo-OdoPto- -eratoprostJesis OO-P Indicated for bilateral end- stage ocular surface disease, autoimmune diseases, and chemical injury; includes a “biological haptic” made from the patient’s tooth and alveolar bone. 3 Miro Cornea UR (Miro VisioP A synthetic, “bio- coated” keratoprosthesis that can support epicorneal or intrastromal implantation, according to the company’s website; 4 indicated for eyes bilaterally blind from corneal disease or injury. AWro -Pro AWrolab Described on the company’s website as similar to the Boston KPro in design and indicated for eyes with opacified corneas that have failed corneal grafts. LVP KPro: Described as an alternative MOOKP for eyes that are completely dry with end stage corneal blindness. 5 *This is not an exhaustive list, and some devices might not be available in the U.S.