Type safe boston

Currently, the Boston KPro is considered by some to be a primary treatment option in cases of repeat graft failure [17] and aniridia [18] , and, by a smaller percentage of surgeons, to be a primary option in cases of herpetic keratitis [19] and pediatric corneal opacities [20]. Pediatric KPro use in particular is still a controversial topic that is widely debated among corneal specialists because of the high level of care needed postoperatively and the possibly devastating complications of the procedure.

Prosthokeratoplasty is the term for a procedure in which a damaged cornea is replaced with an artificial cornea. During implantation of the Boston KPro, the device is assembled with a donor corneal graft positioned between the front and back plate, that is then sutured into place in a similar fashion to PKP.

The surgical procedure may be carried out by any surgeon familiar with PKP, and without the worry of astigmatism due to the rigidity of the assembled device. The current recommendation is removal of the crystalline lens at the time of KPro surgery given the inevitable development of cataract as a result of several factors, including long-term postoperative topical steroid use, surgical trauma and other factors [21]. The primary keratoprosthesis surgery is often combined with other procedures including iridoplasty, glaucoma filtration devices, IOL and lens capsule removal and core vitrectomy.

Please view accompanying video for a detailed review of device assembly and surgical procedure. On the left, preoperative photo of an eye with keratoconus and hand motion vision after multiple failed grafts. This eye had a history of multiple filtration surgeries for advanced glaucoma. On the right, seven month postoperative photo after implantation of Boston type 1 KPro. However, preoperative diagnosis influences clinical outcome after KPro surgery.

The difference in outcomes appears to be related to the degree and cumulative past period of inflammation. Overall most favorable outcomes are achieved in non-cicatrizing conditions, followed by ocular burns and OCP with the worst outcomes in SJS patients.

Closely monitored, long-term follow-up with an ophthalmologist familiar with the KPro is a necessity with the device. Due to the substantial risks of glaucoma and endophthalmitis, it may be best to manage these patients in a team setting consisting of a corneal specialist, glaucoma specialist, and retinal specialist. It must be stressed that KPro eyes require life-long follow-up entailing the commitment of the both the patient and ophthalmologist. The rigorous follow-up should guide patient selection.

Furthermore, patient compliance with postoperative medication is of paramount importance. KPro surgery in a historically non-compliant patient should proceed with extreme caution. Due to incomplete biointegration of hardware in the eye there is a significant risk of infectious endophthalmitis [23] , a devastating complication which often results in a substantial loss of vision. The incidence of IE has been significantly reduced by life-time daily topical antibiotic prophylaxis.

Typical regimes include a topical fourth generation fluoroquinolone moxifloxacin or gatifloxacin with or without topical vancomycin. The increase in incidence of gram-positive IE cases in one study was the basis for the addition of topical vancomycin preserved with 0. Most surgeons recommend a topical fluoroquinolone and topical vancomycin in the initial postoperative period of all KPro eyes and then continuing dual agent coverage in autoimmune a group at higher risk for IE or monocular patients.

Some KPro surgeons recommend antibiotic cycling to prevent microbial resistance, although there are no published studies to support this. Regardless of regime employed, the incidence of this devastating complication is reduced with permanent topical antibiotic prophylaxis and patients should be educated on the important of compliance. Another postoperative management intervention is the indefinite placement of a bandage contact lens BCL.

The BCL has many other added benefits including improving patient comfort and protecting from possible exposed sutures. The benefit of the BCL is multifactorial and can include other therapeutic, refractive and cosmetic roles.

Ocular surface exposure can lead to KPro melt and failure and sometimes a tarshorraphy is necessary in addition to the BCL. The downside to BCL use is the increased risk of infection associated with contact lens use, especially when used on a chronic, extended wear basis. Life-long topical steroids such as prednisolone acetate is necessary in all KPro eyes to prevent inflammation and has been successfully utilized since inception of the device.

It is believed inflammation is the most important factor for RPM formation [11]. Most cases are successfully treated with simple, single session YAG membranotomy.

Typically surgical membranectomy is reserved for cases refractory to YAG laser treatment. The YAG laser should be used with caution at energy greater than 3. Despite best efforts at RPM monitoring and treatment with YAG laser, some patients will ultimately still progress and require more invasive surgical intervention.

In this neighborhood, there is a popular gourmet grocery store called Greek International Food Market and the highly-recommended Sofia Italian Steakhouse.

Maybe what makes West Roxbury popular with families with children, mature professionals and retirees, is its crime rate which is only 1. If you have seen The Departed, then you likely have a Hollywood-inspired image in your head about Charlestown being a major crime center.

Charlestown is not only for young professionals looking for more affordable housing but also for people who want to experience the historic waterfront neighborhood with Irish-American roots. While Charlestown is a small neighborhood, there are a couple standout restaurants that are worth a visit like Monument and Brewer's Fork. It also best embodies the spirit of America in that it holds the most ethnic and income-diverse residents in all of Boston.

Despite the rise in the cost of real estate, the takeover of better eating establishments shows that there is a continuous and welcome change in the community. Nicknamed Eastie by its beloved residents, East Boston has a little over 40, diverse residents and has seen a lot of transformation especially in the areas around the Maverick T stop. One of the most significant issues the neighborhood has faced in the past is its history of crime. However, law enforcement efforts and gentrification have contributed to reducing the crime rate 1.

Few people outside of East Boston realize that there are quite a few great restaurants to be found here, from Santarpio's pizza to Taqueria Jalisco. Hyde Park is a neighborhood in Boston that is known for being low-crime, and for good reason. But what makes people love this town is the fact that it is well-maintained with dashes of green on every corner, offering a respite from the concrete and brick! The town is known for its close proximity to Boston harbor and a number of popular green areas and parks courtesy of father of American landscape architecture Frederick Law Olmsted.

If you plan to visit or relocate, there are sites like The James Blake House the oldest house in Boston , Franklin Park Zoo , Dorchester Park, and Franklin Park to get in some bonding time with your family and loved ones. It's known for having a great selection of restaurants that are of comparable or superior quality to their competitors downtown for a much lower price such as Carlo's Cucina and Coreanos Allston.

In addition, this is one of many areas that the Boston Police Department is delegating a lot of their resources to keeping safe. As of , only 1, total crimes were reported over a population of 64, South Boston or "Southie" was once predominately a working-class Irish Catholic community, but these days, it has become a hot spot for young professionals looking for a swanky new pad only minutes away from their office or a short jaunt on the MBTA.

It is also home to some of the most beautiful real estate in town with many brownstones dating back to centuries ago. For a more relaxing day, check out the Boston Public Library and flip through its massive collection of books or take a stroll through the Public Garden. The Back Bay has some of the best restaurants in the city, along with some of the more high-end spots. Boston's road infrastructure may suffer from a lack of lane markings and confusing one-way streets, but the good news is that the city is small enough to where you can drive from one end to the city of the other reasonably quickly in off-peak hours.

The traffic in and out of the city, especially during rush hours , can be frustrating. So much so that griping about transit problems is a favorite go-to conversation topic.

The Mass Pike, a highway which runs through the heart of Boston. In Boston and its surrounding suburbs, there are reasonably efficient -- if somewhat antiquated -- public transportation systems in place. There are now plenty of sidewalks and pathways that allow one to easily navigate around the busy city districts.

If you do need a car, however, driving isn't all that bad once you learn how to dodge the potholes. Not to mention that Boston drivers all seem to forget that turn signals exist. If you can, it's best to use public transportation for commuting and save the car for running errands or traveling outside of the city. To avoid traffic, keep in mind what weekends there are major sports games scheduled.

Expect slowdowns before and after such events as the streets suddenly fill with cars. Remember to apply for a parking permit if it is not provided by your employer, as parking space in the city is limited. This will vary depending on your qualifications and career choice. Title of your review. Skip to content. Safety Index: Boston does not have earthquakes. There is no earthquakes in Boston. Rated 4. How Safe Is Boston Really? User Reviews Share Your Experience. Country Index City Index. Skip to main content.

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