title: artificial keratoprosthesis for corneal transplant ... · 2016 5 retrospective chart review...
TRANSCRIPT
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TITLE: Artificial Keratoprosthesis for Corneal Transplant: Clinical Effectiveness, Cost Effectiveness, and Guidelines
DATE: 08 February 2016
RESEARCH QUESTIONS
1. What is the clinical effectiveness of artificial keratoprosthesis devices for patients requiring
corneal transplant? 2. What is the cost-effectiveness of artificial keratoprosthesis devices for patients requiring
corneal transplant? 3. What are the evidence-based guidelines regarding appropriate clinical indications for
artificial keratoprosthesis devices? KEY FINDINGS
Three systematic reviews, 27 non-randomized studies, one economic evaluation, and one evidence-based guideline were identified regarding artificial keratoprosthesis devices for patients requiring corneal transplant. METHODS
A limited literature search was conducted on key resources including PubMed, The Cochrane Library, University of York Centre for Reviews and Dissemination (CRD) databases, ECRI, Canadian and major international health technology agencies, as well as a focused Internet search. No filters were applied to limit the retrieval by study type. Where possible, retrieval was limited to the human population. The search was also limited to English language documents published between January 1, 2011 and January 25, 2016. Internet links were provided, where available. The summary of findings was prepared from the abstracts of the relevant information. Please note that data contained in abstracts may not always be an accurate reflection of the data contained within the full article.
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Artificial Keratoprosthesis for Corneal Transplant 2
SELECTION CRITERIA
One reviewer screened citations and selected studies based on the inclusion criteria presented in Table 1.
Table 1: Selection Criteria
Population Patients (of any age) requiring corneal transplant
Intervention Artificial keratoprosthesis devices (e.g., Boston Keratoprosthesis, Alpha Cor Artificial Cornea, Osteo-Odonto-Keratoprosthesis, KeraKlear Artificial
Cornea)
Comparators Human donor corneas;
No comparator
Outcomes Q1: Clinical effectiveness (e.g., visual acuity; restoration of shape, clarity or integrity of cornea; failure rate); Harms
Q2: Cost-effectiveness outcomes Q3: Evidence-based guidelines regarding appropriate clinical indications for artificial keratoprosthesis
Study Designs Health technology assessments, systematic reviews, meta-analyses,
randomized controlled trials, non-randomized studies, evidence-based guidelines
RESULTS
Rapid Response reports are organized so that the higher quality evidence is presented first. Therefore, health technology assessment reports, systematic reviews, and meta-analyses are presented first. These are followed by randomized controlled trials, non-randomized studies, economic evaluations, and evidence-based guidelines. Three systematic reviews, 27 non-randomized studies, one economic evaluation, and one evidence-based guideline were identified regarding artificial keratoprosthesis devices for patients requiring corneal transplant. No health technology assessments or randomized controlled studies were identified. Additional references of potential interest are provided in the appendix.
OVERALL SUMMARY OF FINDINGS
Three systematic reviews,1-3 27 non-randomized studies,4-30 one economic evaluation,31 and one evidence-based guideline32 were identified regarding artificial keratoprosthesis devices for patients requiring corneal transplant. Results from one systematic review1 demonstrated an increased likelihood of visual improvement maintenance in patients with donor corneal graft failure upon the use of the type I Boston keratoprosthesis (KPro) when compared with repeat donor penetrating keratoplasty. In addition, no higher risk of postoperative glaucoma was observed with the KPro.1 The second systematic review also noted successful clinical use of KPro; however, the authors highlighted accessibility issues as problematic (particularly financial issues, lack of adequately trained surgeons, and shortages of donor corneas).2 The third systematic review limited its inclusion criteria to randomized controlled trials. It did not identify any trials and was subsequently unable
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Artificial Keratoprosthesis for Corneal Transplant 3
to determine optimal treatment with regard to Artificiall (keratoprosthesis) corneas in patients who had failed conventional corneal transplant.3 Twenty-seven4-30 non-randomized studies were identified regarding artificial keratoprosthesis devices for patients requiring corneal transplant. While most studies identified some improvement in visual acuity, complications remain a concern. Study details and conclusions are provided in Table 2.
Table 2: Summary of Findings from Non-Randomized Studies First Author,
Year
Study Type,
Size Indications Outcomes Conclusions
Auro Keratoprosthesis
Sharma, 20154 Prospective
interventional study
N=10 eyes (in 10 patients)
End-stage corneal disease
BCVA
Retention
Complications
Need for second
surgery
Viable option in end-stage corneal disease.
9/10 patients retained
keratoprosthesis.
Complications were observed.
Boston Type I Keratoprosthesis
Wagoner, 2016
5
Retrospective chart review
N=75 KPro-I procedures
NR Post-operative infections
Post-operative infections are a serious
issue compromising retention of KPro-1 and visual outcomes.
Hager, 20157 Retrospective
review
N=24
Failed
keratoplasty: o Corneal
edema
(n=13) o Trauma
(n=8)
o Keratononus (n=3)
BCVA
Retention
In patients with failed
keratoplasty, the KPro-I was associated with: o excellent prognosis
of retention; o satisfactory visual
improvement.
Kosker, 20158 Retrospective
analysis
N=37 eyes (in
37 patients)
Preoperative BCVA=20/40 in
fellow eye
Failed penetrating keratoplasy
(n=28)
Primary KPro (n=9)
BCVA
Retention
Complications
Half of the patients achieved minimum VA required for binocular
functioning.
One-third of patients achieved a BCVA
somewhat similar to fellow eye.
Good retention.
Complications similar to previously reported.
Phillips, 20159 Retrospective
review
N=4
Failed keratoplasties: o Iris atrophy
(n=2) o Chandler
syndrome
(n=2)
BCVA KPro-I may offer a better prognosis than traditional keratoplasty
in reestablishing corneal clarity in patients with iridocorneal endothelial
syndromes.
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Artificial Keratoprosthesis for Corneal Transplant 4
Table 2: Summary of Findings from Non-Randomized Studies
First Author, Year
Study Type, Size
Indications Outcomes Conclusions
Rudnisky, 2015
10
Prospective parameters were collected
N=300 eyes (of 300 patients)
NR logMAR visual outcomes
KPro-I is an effective device for rehabilitation in advanced ocular
surface disease that results in significantly improved VA.
Brown, 201411
Retrospective
review
N=9 eyes
Keratopathy
caused by: o HSV o HZV
Visual outcomes
Retention
Complications
In eyes with HSV
keratopathy, KPro-I is associated with: o excellent prognosis
for retention; o highly satisfactory
visual improvement;
o acceptably low prevalence of sight-threatening
complications.
Aforementioned results were not observed in
eyes with HZV keratoplasty.
de Oliveira, 2014
12
Prospective interventional study
N=30 eyes (of 30 patients)
Failed graft (n=16)
Chemical injury
(n=10)
Stevens-Johnson
syndrome (n=4)
VA
KPro-I stability
Postoperative
complications
In the developing world, KPro-I keratoprosthesis is a viable option after
multiple keratoplasty failures and in conditions with a poor
prognosis for keratoplasty.
de Rezende Couto
Nascimento, 2014
13
Retrospective chart analysis
N=59 eyes (in 57 patients)
Various diagnoses
(most non-standard for KPro-I
implantation)
How primary diagnoses affect
post-operative VA
Complications
Most cases showed improvement in VA.
Posterior segment complications and infections resulted in
persistent loss of vision.
Phillips, 201414
Retrospective review
N=9 eyes
Alkali burns (n=7
Acid burns (n=1)
Thermal burns (n=1)
Visual outcomes
Retention
Complications
In most cases, KPro-I is associated with: o highly satisfactory
visual outcomes;
o prosthesis retention; o serious
complications are
common.
Ciolino, 201315
Prospective study
N=300 eyes (in 300 patients)
NR Retention KPro-I seems to be viable option for non-
candidates of PK
Ocular surface disease due to autoimmune
disease had lowest retention rate.
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Artificial Keratoprosthesis for Corneal Transplant 5
Table 2: Summary of Findings from Non-Randomized Studies
First Author, Year
Study Type, Size
Indications Outcomes Conclusions
Goldman, 2013
16
Retrospective chart review
N=98 eyes (of
94 patients)
NR Posterior segment completions
These complications occur in a significant percentage of patients,
resulting in persistent reduction in VA.
Magalhaes, 2013
17
Prospective study
N=10 eyes (in 10 patients)
Ocular burns VA
Retention
Complications
There is support for the use of the KPro-I in
managing bilateral LSCD secondary to ocular burns.
Munoz-
Gutierrez, 2013
18
Retrospective
analysis
N=41 eyes (in 387 patients)
Most frequent
diagnoses were bullous keratopathy,
autoimmune diseases
Visual function
Complications
Visual function
improved in most patients.
Increased risk for serious sight-
threatening complications in patient with prior multiple ocular
surgeries and alterations of systemic immunity.
Palioura,
201319
Retrospective
review
N=8 eyes (of 8 patients)
Mucous
membrane pemphigoid
VA
Retention
Complications
Clinical outcomes
associated with KPro-I implantation in these patients are guarded.
Chan, 201220
Retrospective chart review
N=10 cases
Chemical injuries (n=4)
Stevens-Johnson syndrome (n=3)
Ocular cicatricial pemphigoid
(n=2)
Congenital aniridia (n=1)
Infectious keratitis
Infectious keratitis can occur even when
patients are on prophylactic vancomycin and 4
th-
generation fluoroquinolone.
Reported case of ocular
D. constricta.
Patel, 201221
Retrospective chart review
N=58 eyes (in 51 patients)
Various conditions
VA
Retention
Complications
KPro-I provides visual recovery for eyes with
multiple PK failures or in those with a poor prognosis for primary
PK.
Excellent retention rates.
Trend towards decline in VA with time and late complications.
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Artificial Keratoprosthesis for Corneal Transplant 6
Table 2: Summary of Findings from Non-Randomized Studies
First Author, Year
Study Type, Size
Indications Outcomes Conclusions
Ramchandran, 2012
22
Retrospective chart review
N=10 eyes
Infectious endophthalmitis
Clinical characteristics of infectious
endophthalmitis after implantation
Higher incidence, delayed onset, and high risk for recurrence of
infectious endophthalmitis compared with
postoperative endophthalmitis.
Concurrent use of
topical vancomycin is recommended.
Shihadeh, 2012
23
Retrospective chart review
N=20 eyes (in 19 patients)
NR BCVA
Complications
Reasonable safe and effective for patients
with corneal blindness (and those for whom prognosis is poor for
natural corneal grafting).
Greiner, 2011
24
Cohort study
N=36 eyes
Failed corneal transplants (n=19)
Chemical injury (n=10)
Aniridia (n=5)
VA
Complications
Viable option for salvaging vision; however, some patients
lost vision over postoperative course.
Glaucoma and
complications related to glaucoma remain significant challenges.
Sejpal, 201125
Retrospective
review
N=28 procedures (in 23 eyes of 22
patients)
LSCD VA
Retention
Complications
KPro-I results in
significant CDVA improvement in majority of LSCD patients and
CDVA of 20/50 or better in more than two-thirds of patients 3 years post-
surgery.
PED was the most common complication.
PED is associated with
increased rate of sterile stromal necrosis and lower retention rates.
Boston Type I and II Keratoprosthesis
Duignan,
20156
Retrospective
chart review
N=31 (KPro-I implantations)
N=3 (KPro-II
implantations)
NR BCVA
Retention
Complications
Excellent VA and
retention in a long follow-up (42 months, SD 31 months).
Complications remain considerable source of morbidity.
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Artificial Keratoprosthesis for Corneal Transplant 7
Table 2: Summary of Findings from Non-Randomized Studies
First Author, Year
Study Type, Size
Indications Outcomes Conclusions
KeraKlear Kpro
Alio, 201527
Prospective study
N=15a
High risk of failure with PK
Retention
Complications
Viable alternative to corneal transplantation.
KeraKlear KPro is better
tolerated and less prone to complications with epidescemetical
implantation.
Cases with poor corneal quality are better
associated to lamellar fenestrated donor corneal graft.
Osteo-Odonto-Keratoprosthesis
Lee, 201428
Prospective study
N=18
OOKP (n=9)
age-matched
controls (n=9)
Optical and visual performance
OOKP provides patients with good level of VA,
with significant reductions in glare.
Narayanan, 2012
29
Retrospective analysis
N=26
Blindness occurring due
to: o Stevens-
Johnson
syndrome (n=23)
o Chemical
burns (n=3)
VA
Complications
Successful visual rehabilitation occurred
in 19 patients
No improvement in 4 patients.
de la Paz, 2011
30
Retrospective cohort study
N=227
Various indications
Effect of clinical factors on long-term anatomical
function and functional success
Surgical technique, primary diagnosis, age, and postoperative
complications can affect long-term function and functional success of
OOKP. BCVA = best corrected visual acuity; CDVA = corrected distance visual acuity; HSV = herpes simplex virus; HZV = herpes zoster virus; KPro-I = Boston type I keratoprosthesis; logMAR = lorgarithm of the minimal angle of resolution; LSCD = corneal limbal stem cell deficiency; NR = not reported; OOKP = Osteo-Odonto-Keratoprosthesis; PED = persistent corneal epithelial defect; PK = penetrating keratoplasty; SD = standard deviation; VA = visual acuity. a epidescemetic KPro w as implanted intralamellar in 11eyes and epidescemetical in four eyes.
The authors of the one identified economic analysis31 reported that, from the perspective of the third party payer, the use of the type II KPro was associated with a cost utility of $63,196 per quality adjusted life year. Thus, the authors concluded that decreases in both patient and societal costs may be realized when efforts were put forth to identify patients less likely to benefit from either type I KPro or traditional corneal transplantation.31 With regard to appropriate clinical indications for artificial keratoprosthesis devices, the American Academy of Ophthalmology32 noted that keratoprosthesis devices are being used for unilateral or bilateral ocular trauma, unilateral or bilateral herpetic keratitis, unilateral or bilateral aniridia, unilateral or bilateral Steven-Johnson syndrome, and unilateral or bilateral congenital corneal opacification; however, the evidence for all of these indications was determined to be
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Artificial Keratoprosthesis for Corneal Transplant 8
grade III, insufficient and discretionary. In addition, osteo-odonto-keratoprosthesis has provided some success for patients with severe dry eye and autoimmume ocular surface diseases; however, the evidence was graded as III, insufficient and discretionary.32
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Artificial Keratoprosthesis for Corneal Transplant 9
REFERENCES SUMMARIZED
Health Technology Assessments
No literature identified. Systematic Reviews and Meta-analyses
1. Ahmad S, Mathews PM, Lindsley K, Alkharashi M, Hwang FS, Ng SM, et al. Boston type 1
keratoprosthesis versus repeat donor keratoplasty for corneal graft failure: a systematic review and meta-analysis. Ophthalmology. 2016 Jan;123(1):165-77. PubMed: PM26545318
2. Al Arfaj K. Boston keratoprosthesis - clinical outcomes with wider geographic use and
expanding indications - a systematic review. Saudi J Ophthalmol [Internet]. 2015 Jul [cited 2016 Feb 5];29(3):212-21. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487949 PubMed: PM26155082
3. Akpek EK, Alkharashi M, Hwang FS, Ng SM, Lindsley K. Artificial corneas versus donor corneas for repeat corneal transplants. Cochrane Database Syst Rev [Internet]. 2014 Nov 5 [cited 2016 Feb 5];11:CD009561. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270365 PubMed: PM25372407
Randomized Controlled Trials
No literature identified. Non-Randomized Studies
Auro Keratoprosthesis 4. Sharma N, Falera R, Arora T, Agarwal T, Bandivadekar P, Vajpayee RB. Evaluation of a
low-cost design keratoprosthesis in end-stage corneal disease: a preliminary study. Br J Ophthalmol. 2015 Aug 13. [Epub ahead of print] PubMed: PM26271267
Boston Type I or II Keratoprosthesis 5. Wagoner MD, Welder JD, Goins KM, Greiner MA. Microbial keratitis and endophthalmitis
after the Boston type 1 keratoprosthesis. Cornea. 2016 Jan 13. [Epub ahead of print] PubMed: PM26764885
6. Duignan ES, Ni Dhubhghaill S, Malone C, Power W. Long-term visual acuity, retention
and complications observed with the type-I and type-II Boston keratoprostheses in an Irish population. Br J Ophthalmol. 2015 Dec 1. [Epub ahead of print] PubMed: PM26628625
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Artificial Keratoprosthesis for Corneal Transplant 10
7. Hager JL, Phillips DL, Goins KM, Kitzmann AS, Greiner MA, Cohen AW, et al. Boston type 1 keratoprosthesis for failed keratoplasty. Int Ophthalmol. 2015 May 16. [Epub ahead of print]. PubMed: PM25975459
8. Kosker M, Suri K, Rapuano CJ, Ayres BD, Nagra PK, Raber IM, et al. Long-term results of
the Boston keratoprosthesis for unilateral corneal disease. Cornea. 2015 Sep;34(9):1057-62. PubMed: PM26114818
9. Phillips DL, Goins KM, Greiner MA, Alward WL, Kwon YH, Wagoner MD. Boston type 1
keratoprosthesis for iridocorneal endothelial syndromes. Cornea. 2015 Nov;34(11):1383-6. PubMed: PM26398156
10. Rudnisky CJ, Belin MW, Guo R, Ciolino JB, Boston Type 1 Keratoprosthesis Study Group.
Visual acuity outcomes of the Boston keratoprosthesis type 1: multicenter study results. Am J Ophthalmol. 2015 Nov 10. [Epub ahead of print]. PubMed: PM26550696
11. Brown CR, Wagoner MD, Welder JD, Cohen AW, Goins KM, Greiner MA, et al. Boston
keratoprosthesis type 1 for herpes simplex and herpes zoster keratopathy. Cornea. 2014 Aug;33(8):801-5. PubMed: PM24932767
12. de Oliveira LA, Pedreira Magalhães F, Hirai FE, de Sousa LB. Experience with Boston
keratoprosthesis type 1 in the developing world. Can J Ophthalmol. 2014 Aug;49(4):351-7. PubMed: PM25103652
13. de Rezende Couto Nascimento V, de la Paz MF, Rosandic J, Stoiber J, Seyeddain O,
Grabner G, et al. Influence of primary diagnosis and complications on visual outcome in patients receiving a Boston type 1 keratoprosthesis. Ophthalmic Res. 2014;52(1):9-16. PubMed: PM24853485
14. Phillips DL, Hager JL, Goins KM, Kitzmann AS, Greiner MA, Cohen AW, et al. Boston type
1 keratoprosthesis for chemical and thermal injury. Cornea. 2014 Sep;33(9):905-9. PubMed: PM25055151
15. Ciolino JB, Belin MW, Todani A, Al-Arfaj K, Rudnisky CJ, Boston Keratoprosthesis Type 1 Study Group. Retention of the Boston keratoprosthesis type 1: multicenter study results. Ophthalmology [Internet]. 2013 Jun [cited 2016 Feb 5];120(6):1195-200. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674188 PubMed: PM23499061
16. Goldman DR, Hubschman JP, Aldave AJ, Chiang A, Huang JS, Bourges JL, et al.
Postoperative posterior segment complications in eyes treated with the Boston type I keratoprosthesis. Retina. 2013 Mar;33(3):532-41. PubMed: PM23073339
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Artificial Keratoprosthesis for Corneal Transplant 11
17. Magalhães FP, Hirai FE, de Sousa LB, de Oliveira LA. Boston type 1 keratoprosthesis outcomes in ocular burns. Acta Ophthalmol. 2013 Sep;91(6):e432-e436. PubMed: PM23406295
18. Muñoz-Gutierrez G, Alvarez de Toldeo J, Barraquer RI, Vera L, Couto Valeria R, Nadal J,
et al. Post-surgical visual outcome and complications in Boston type 1 keratoprosthesis. Arch Soc Esp Oftalmol. 2013 Feb;88(2):56-63. PubMed: PM23433193
19. Palioura S, Kim B, Dohlman CH, Chodosh J. The Boston keratoprosthesis type I in
mucous membrane pemphigoid. Cornea. 2013 Jul;32(7):956-61. PubMed: PM23538625
20. Chan CC, Holland EJ. Infectious keratitis after Boston type 1 keratoprosthesis
implantation. Cornea. 2012 Oct;31(10):1128-34. PubMed: PM22960647
21. Patel AP, Wu EI, Ritterband DC, Seedor JA. Boston type 1 keratoprosthesis: the New
York Eye and Ear experience. Eye (Lond) [Internet]. 2012 Mar [cited 2016 Feb 5];26(3):418-25. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298984 PubMed: PM22173079
22. Ramchandran RS, Diloreto DA Jr, Chung MM, Kleinman DM, Plotnik RP, Graman P, et al. Infectious endophthalmitis in adult eyes receiving Boston type I keratoprosthesis. Ophthalmology. 2012 Apr;119(4):674-81. PubMed: PM22266108
23. Shihadeh WA, Mohidat HM. Outcomes of the Boston keratoprosthesis in Jordan. Middle East Afr J Ophthalmol [Internet]. 2012 Jan [cited 2016 Feb 5];19(1):97-100. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277032 PubMed: PM22346122
24. Greiner MA, Li JY, Mannis MJ. Longer-term vision outcomes and complications with the Boston type 1 keratoprosthesis at the University of California, Davis. Ophthalmology. 2011 Aug;118(8):1543-50. PubMed: PM21397948
25. Sejpal K, Yu F, Aldave AJ. The Boston keratoprosthesis in the management of corneal limbal stem cell deficiency. Cornea. 2011 Nov;30(11):1187-94. PubMed: PM21885964
26. Verdejo-Gómez L, Peláez N, Gris O, Güell JL. The Boston Type I keratoprosthesis: an assessment of its efficacy and safety. Ophthalmic Surg Lasers Imaging. 2011 Nov;42(6):446-52. PubMed: PM21919432
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Artificial Keratoprosthesis for Corneal Transplant 12
KeraKlear Kpro 27. Alio JL, Abdelghany AA, Abu-Mustafa SK, Zein G. A new epidescemetic keratoprosthesis:
pilot investigation and proof of concept of a new alternative solution for corneal blindness. Br J Ophthalmol. 2015 Nov;99(11):1483-7. PubMed: PM25868791
Osteo-Odonto-Keratoprosthesis 28. Lee RM, Ong GL, Lam FC, White J, Crook D, Liu CS, et al. Optical functional performance
of the osteo-odonto-keratoprosthesis. Cornea. 2014 Oct;33(10):1038-45. PubMed: PM25127188
29. Narayanan V, Nirvikalpa N, Rao SK. Osteo-odonto-keratoprosthesis - a maxillofacial
perspective. J Craniomaxillofac Surg. 2012 Dec;40(8):e426-e431. PubMed: PM22425501
30. de la Paz MF, de Toledo JA, Charoenrook V, Sel S, Temprano J, Barraquer RI, et al.
Impact of clinical factors on the long-term functional and anatomic outcomes of osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis. Am J Ophthalmol. 2011 May;151(5):829-39. PubMed: PM21310387
Economic Evaluations
31. Ament JD, Stryjewski TP, Pujari S, Siddique S, Papaliodis GN, Chodosh J, et al. Cost
effectiveness of the type II Boston keratoprosthesis. Eye (Lond) [Internet]. 2011 Mar [cited 2016 Feb 5];25(3):342-9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178310 PubMed: PM21183944
Guidelines and Recommendations
32. American Academy of Ophthalmology Cornea/External Disease Panel. Corneal edema
and opacification [Internet]. San Francisco: American Academy of Ophthalmology; 2013 [cited 2016 Feb 5]. (Preferred Practice Pattern® guideline). Available from: http://www.aao.org/preferred-practice-pattern/corneal-edema-opacification-ppp--2013 See: Keratoprosthesis
PREPARED BY:
Canadian Agency for Drugs and Technologies in Health Tel: 1-866-898-8439 www.cadth.ca
http://www.ncbi.nlm.nih.gov/pubmed/25868791http://www.ncbi.nlm.nih.gov/pubmed/25127188http://www.ncbi.nlm.nih.gov/pubmed/22425501http://www.ncbi.nlm.nih.gov/pubmed/21310387http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178310http://www.ncbi.nlm.nih.gov/pubmed/21183944http://www.aao.org/preferred-practice-pattern/corneal-edema-opacification-ppp--2013http://www.cadth.ca/
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Artificial Keratoprosthesis for Corneal Transplant 13
APPENDIX – FURTHER INFORMATION:
Non-Randomized Studies - Alternate Comparator
33. Fadous R, Levallois-Gignac S, Vaillancourt L, Robert MC, Harissi-Dagher M. The Boston
Keratoprosthesis type 1 as primary penetrating corneal procedure. Br J Ophthalmol. 2015 Dec;99(12):1664-8. PubMed: PM26034079
Review Articles
34. Avadhanam VS, Liu CS. A brief review of Boston type-1 and osteo-odonto
keratoprostheses. Br J Ophthalmol. 2015 Jul;99(7):878-87. PubMed: PM25349081
35. Avadhanam VS, Smith HE, Liu C. Keratoprostheses for corneal blindness: a review of
contemporary devices. Clin Ophthalmol [Internet]. 2015 [cited 2016 Feb 5];9:697-720. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406263 PubMed: PM25945031
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Additional References
42. Keratoprosthesis algorithm [Internet]. San Francisco: American Academy of
Ophthalmology; c2016 [cited 2016 Feb 5]. Available from: http://www.aao.org/image/keratoprosthesis-algorithm
http://www.aao.org/image/keratoprosthesis-algorithm
Research questionSkey FINDINGSMethodsResultsOverall summary of findingsReferences summarizedAppendix – Further information:Review Articles