Lucia and Beyond: Development of an Affordable Keratoprosthesis
Lucia and Beyond: Development of an Affordable Keratoprosthesis
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DOI：
10.1097/ico.0000000000001880
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发表时间：
2019-04-01
期刊：
影响因子：
2.8
通讯作者：
Chodosh, James
中科院分区：
文献类型：
--
作者：
Bakshi, Shaunak K.;Paschalis, Eleftherios I.;Chodosh, James
目的：严重的角膜疾病是全球失明负担的重要组成部分。角膜异体移植手术仍然是最常用的治疗方法，但并不是每个病人都能长期成功，而且每次移植成功的几率都在下降。波士顿I型角膜假体已成为重复角膜同种异体移植的替代方法。然而，成本限制了其在资源贫乏地区的应用，而大多数角膜失明患者居住在这些地区。方法：对波士顿角膜假体设计过程的各个方面进行检查，以确定潜在的修改和简化区域，以降低成本和改善设备的外观。结果：部件设计的微小修改简化了角膜假体的制造。采用单一无晶状眼轴向长度和单一后板直径可以进一步减少比例机械师的时间。通过将后板孔的形状从圆形改为径向，具有花瓣状外观，并通过对后板钛进行阳极氧化，以赋予更自然的颜色，从而改善了外观。结论：我们开发了一种改良的波士顿I型角膜假体，我们称之为“Lucia”。Lucia保留了2件式设计和易于组装的谓词设备，但将允许以降低的成本制造。它的外观应该更容易被植入的病人接受。成功的角膜移植结果需要患者终生每日用药和严格、频繁的术后护理。在资源贫乏的环境中有效实施该设备将需要眼科保健服务的进一步创新。
Purpose: Severe corneal disease contributes significantly to the global burden of blindness. Corneal allograft surgery remains the most commonly used treatment, but does not succeed long term in every patient, and the odds of success fall with each repeated graft. The Boston keratoprosthesis type I has emerged as an alternative to repeat corneal allograft. However, cost limits its use in resource-poor settings, where most corneal blind individuals reside.Methods: All aspects of the Boston keratoprosthesis design process were examined to determine areas of potential modification and simplification, with dual goals to reduce cost and improve the cosmetic appearance of the device in situ.Results: Minor modifications in component design simplified keratoprosthesis manufacturing. Proportional machinist time could be further reduced by adopting a single axial length for aphakic eyes, and a single back plate diameter. The cosmetic appearance was improved by changing the shape of the back plate holes from round to radial, with a petaloid appearance, and by anodization of back plate titanium to impute a more natural color.Conclusions: We have developed a modified Boston keratoprosthesis type I, which we call the "Lucia." The Lucia retains the 2 piece design and ease of assembly of the predicate device, but would allow for manufacturing at a reduced cost. Its appearance should prove more acceptable to implanted patients. Successful keratoprosthesis outcomes require daily medications for the life of the patient and rigorous, frequent, postoperative care. Effective implementation of the device in resource-poor settings will require further innovations in eye care delivery.