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Comparison of candidate materials for a synthetic osteo-odonto keratoprosthesis device


Tan, XW and Perera, AP and Tan, A and Tan, D and Khor, KA and Beuerman, RW and Mehta, JS, Comparison of candidate materials for a synthetic osteo-odonto keratoprosthesis device, Investigative Ophthalmology and Visual Science, 52, (1) pp. 21-29. ISSN 0146-0404 (2011) [Refereed Article]

Copyright Statement

Copyright 2011 The Association for Research in Vision and Ophthalmology, Inc.

DOI: doi:10.1167/iovs.10-6186


Osteo-odonto keratoprosthesis is one of the most successful forms of keratoprosthesis surgery for end-stage corneal and ocular surface disease. There is a lack of detailed comparison studies on the biocompatibilities of different materials used in keratoprosthesis. The aim of this investigation was to compare synthetic bioinert materials used for keratoprosthesis surgery with hydroxyapatite (HA) as a reference.


Test materials were sintered titanium oxide (TiO(2)), aluminum oxide (Al(2)O(3)), and yttria-stabilized zirconia (YSZ) with density >95%. Bacterial adhesion on the substrates was evaluated using scanning electron microscopy and the spread plate method. Surface properties of the implant discs were scanned using optical microscopy. Human keratocyte attachment and proliferation rates were assessed by cell counting and MTT assay at different time points. Morphologic analysis and immunoblotting were used to evaluate focal adhesion formation, whereas cell adhesion force was measured with a multimode atomic force microscope.


The authors found that bacterial adhesion on the TiO(2), Al(2)O(3), and YSZ surfaces were lower than that on HA substrates. TiO(2) significantly promoted keratocyte proliferation and viability compared with HA, Al(2)O(3,) and YSZ. Immunofluorescent imaging analyses, immunoblotting, and atomic force microscope measurement revealed that TiO(2) surfaces enhanced cell spreading and cell adhesion compared with HA and Al(2)O(3).


TiO(2) is the most suitable replacement candidate for use as skirt material because it enhanced cell functions and reduced bacterial adhesion. This would, in turn, enhance tissue integration and reduce device failure rates during keratoprosthesis surgery.

Item Details

Item Type:Refereed Article
Keywords:biomaterials, eye surgery
Research Division:Biomedical and Clinical Sciences
Research Group:Ophthalmology and optometry
Research Field:Optical technology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Perera, AP (Mrs Agampodi Perera)
ID Code:120567
Year Published:2011
Web of Science® Times Cited:20
Deposited By:Ecology and Biodiversity
Deposited On:2017-08-29
Last Modified:2017-10-24

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