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Published on: September 12, 2014
Retroprosthetic membranes in AlphaCor patients: risk factors and prevention
Celia R Hicks1, Stephen Hamilton
1Biomaterials Research Centre, Lions Eye Institute, University of Western Australia, Perth, Australia. crhicks@cyllene.uwa.edu.au
Purpose:
To report retroprosthetic membrane (RPM) formation in association with AlphaCor and identify risk factors for their formation and strategies for prevention and management.
Methods:
Review of AlphaCor data and case histories and literature review.
Results:
RPMs occurred with AlphaCor in 14 (9.3%) cases. We find significant associations with systemic risk factors (race, hypertension, diabetes mellitus) rather than ocular history, but perioperative management may also be related to risk of RPM development. Histology demonstrates a fibrovascular tissue resembling scarred corneal tissue. Similar histologic findings have been reported for other devices.
Conclusion:
Retrocorneal membranes and RPMs with earlier keratoprostheses have frequently been reported without specific identifiable causes. Diabetes is known to be associated with intraocular membrane formation. This study demonstrates that systemic factors affect the risk of RPM formation with AlphaCor. In cases identified as at greater risk of membrane formation, peri- and postoperative therapies such as steroids, non-steroidals, heparin or rTPA should be considered. In our series, several therapeutic and surgical strategies appear effective but recognizing patients at increased risk pre-operatively and using preventive measures where indicated is likely to be key to minimizing the incidence of this complication.
Insights
Retroprosthetic membrane (RPM) formation after AlphaCor implantation is linked to systemic factors like diabetes and hypertension, not just eye history. Early intervention and preventive measures are key to minimizing this complication.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Corneal Surgery
Background:
- Retroprosthetic membranes (RPMs) are a known complication of keratoprostheses.
- Previous studies have reported RPMs with various devices without clear causative factors.
Purpose of the Study:
- To investigate the incidence of RPM formation with the AlphaCor keratoprosthesis.
- To identify systemic and perioperative risk factors associated with RPM development.
- To explore strategies for RPM prevention and management.
Main Methods:
- Retrospective review of AlphaCor implantation cases.
- Analysis of patient data, case histories, and relevant medical literature.
Main Results:
- RPMs were observed in 9.3% of AlphaCor cases (14 out of 150).
- Significant associations found with systemic risk factors including race, hypertension, and diabetes mellitus.
- Histological analysis revealed fibrovascular tissue similar to scarred corneal tissue.
Conclusions:
- Systemic factors, particularly diabetes, play a significant role in RPM formation with AlphaCor.
- Perioperative management and preventive strategies are crucial for mitigating RPM risk.
- Consideration of therapies like steroids, NSAIDs, heparin, or tPA in high-risk patients may reduce incidence.
