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Results with artificial cornea improving, evolving

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WASHINGTON — With an “evolving surgical technique” and an increasing understanding of risk factors for complications, investigators are seeing improving results with the AlphaCor artificial cornea, according to a speaker here.

R. Doyle Stulting, MD, reported results-to-date with the AlphaCor implant in a presentation at the American Society of Cataract and Refractive Surgery meeting. The device, developed in Australia, was approved for use in the United States in 2002. Since the U.S. approval, cases here account for 59% of the total of 239 implants by 69 surgeons, Dr. Stulting said. Follow-up in these eyes ranges from 1 month to 6 years.

The AlphaCor, developed by Argus Biomedical, is distributed in the United States by CooperVision Surgical. The 7-mm-diameter, one-piece device has a central transparent optic surrounded by a biointegratable skirt. It is used in patients who are considered too high-risk for a corneal transplant, Dr. Stulting said. Patients receiving the implant have had as many as 13 previous failed grafts, he said.

Preoperative best corrected visual acuity ranged from light perception to 20/200, Dr. Stulting said, and postop BCVA ranged from light perception to 20/20, with a mean gain of 2 lines of vision.

Increasing experience with the implant — now up to “251 patient-years,” according to Dr. Stulting — has resulted in improved results and a better understanding of risk factors, he said. Corneal melting, which in early trials occurred in as many as 83% of eyes, is now experienced in only about 12% of cases, he said. Retroprosthetic membranes, which were seen in 13.5% of cases, have been found to be associated with race, hypertension and diabetes mellitus. Procedures to prevent postop complications, such as the use of soft contact lenses, have also been identified with increasing experience, Dr. Stulting said.