Seminars in Ophthalmology最新文献

Purpose: To synthesize contemporary evidence on Boston KPro outcomes in autoimmune cohorts and outline practical strategies to improve anatomic retention and visual results.

Methods: A review.

Results: The Boston keratoprosthesis (KPro) is the most widely implanted artificial cornea and a critical option for visual rehabilitation in patients at high risk of graft failure. Autoimmune disorders, including Stevens-Johnson syndrome (SJS), Sjögren's disease (SjD), ocular mucous membrane pemphigoid (OMMP), and ocular graft-versus-host disease (oGVHD), create highly inflammatory, cicatricial ocular surface environments characterized by severe dry eye, limbal stem cell deficiency, and corneal neovascularization, all of which undermine conventional keratoplasty. While selected patients with a relatively "wet" and medically quiet surface can benefit from Type 1 KPro, most end-stage cicatricial phenotypes are better served by Type 2 KPro or alternative mucous-membrane-covered devices. Across studies, autoimmune etiology is consistently associated with higher rates of tissue melt, infectious/sterile keratitis, retroprosthetic membrane, glaucoma, and vitreoretinal complications compared with non-autoimmune eyes. A structured perioperative bundle, systemic disease quiescence for ≥3 months, rheumatology co-management, prophylactic glaucoma drainage devices when indicated, long-term bandage contact lens wear, and intensified antibiotic ± antifungal prophylaxis appear to mitigate risk. Emerging approaches (biologics, donor-carrier crosslinking, γ-irradiated tissue, and newer KPro designs) show promise but require standardized endpoints and multicenter registries.

Conclusion: Despite substantial challenges, the Boston KPro remains a vision-restoring option for carefully selected autoimmune patients when performed within multidisciplinary programs using rigorous preventive protocols.

Purpose: This study aims to analyze the expression of presumably critical inflammatory mediators including cytokines, chemokines, secretory, binding, and matrix proteins, and IgE in Vernal keratoconjunctivitis (VKC)-relevant age groups: children, adolescents, and adults.

Methods: The tears (n = 16) and serum (n = 12) samples from active, chronic VKC cases, without treatment at the time of sampling, were collected from the tertiary eye care centers of L V Prasad Eye Institute, located in Hyderabad and Bhubaneswar, during 2021-2022. The age-matched healthy individuals were taken as controls. The subjects were grouped as: children (1-11 years), adolescents (12-21 years), and adults (> 21 years). The expression of a specific panel of Th1- (IL-36γ and MMP-9) and Th2-inflammatory mediators (IL-6, Vitamin D-binding protein (VDBP), MUC5AC, FcεR1, MCP-1, IgE, GM-CSF) was analyzed through ELISA.

Results: Compared to controls, the expression of IgE was upregulated in tears and serum samples of all VKC patients, whereas IL-6, MMP-9, and MUC5AC were upregulated, and VDBP was downregulated in children's tear samples. The VDBP and MCP-1 recorded the highest and lowest protein expression (pg/ml) among all the inflammatory mediators, respectively. The IL-36γ was upregulated in tears and serum samples of adolescents and adults.

Conclusions: Our results suggest differential expressions of chosen Th1- and Th2-mediators in tears and serum samples of children, adolescents, and adults with active VKC. Compared with controls, our findings specifically suggest: i) upregulation of IgE, IL-6, MMP-9, and MUC5AC, and downregulation of VDBP in tear samples of children, and ii) upregulation of IgE and IL-36γ in adolescents and adults.