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This study aims to enhance the antimicrobial properties of the titanium (Ti) backplate of the BKPro by ion implanting silver and copper ions to achieve effective infection control while maintaining cytocompatibility. Research on antimicrobial modifications for BKPro is limited, and while metallic ions like Ag and Cu show promise for biomaterial improvement, their effects on human corneal keratocytes (HCKs) require further study. Ag and Cu were implanted onto rough Ti surfaces, as mono- and coimplantations. Cytotoxicity was assessed in HCKs, and antimicrobial efficacy was tested against\n            <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n            and\n            <jats:italic>Candida albicans<\/jats:italic>\n            . After 21 d, monoimplanted Ag samples released 300.4 ppb of Ag\n            <jats:sup>+<\/jats:sup>\n            , coimplanted samples released 427.5 ppb of Ag\n            <jats:sup>+<\/jats:sup>\n            and 272.3 ppb of Cu ions, and monoimplanted Cu samples released 567.0 ppb of Cu ions. All ion-implanted surfaces supported HCK proliferation, exhibited no cytotoxicity, and showed strong antimicrobial activity. Ag-implanted surfaces provided antibacterial effects through membrane disruption and reactive oxygen species generation, while Cu-implanted surfaces exhibited antifungal effects via impaired enzymatic functions and reactive oxygen species. Coimplanted AgCu surfaces demonstrated synergistic antimicrobial effects, resulting from the synergy between the bactericidal actions of Ag and the oxidative stress contributions of Cu. Additionally, ion-implanted surfaces enhanced HCK adhesion under co-culture conditions. In conclusion, ion implantation effectively imparts antimicrobial properties to the Ti backplate of BKPro, reducing infection risks while preserving compatibility with corneal cells.\n          <\/jats:p>","DOI":"10.34133\/bmr.0147","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T15:48:32Z","timestamp":1737647312000},"update-policy":"https:\/\/doi.org\/10.34133\/aaas_crossmark_01","source":"Crossref","is-referenced-by-count":8,"title":["Synergistic Dual Ag\/Cu Ion Implantation to Enhance Antimicrobial Defense on Boston Keratoprosthesis"],"prefix":"10.34133","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8969-8200","authenticated-orcid":true,"given":"Silvia G.","family":"G\u00f3mez","sequence":"first","affiliation":[{"name":"Biomechanics, Biomaterials and Tissue Engineering, Department of Materials Science and Engineering, \rUniversitat Polit\u00e8cnica de Catalunya \u00b7 BarcelonaTech (UPC), Barcelona 08019, Spain."},{"name":"Barcelona Research Centre in Multiscale Science and Engineering, \rUniversitat Polit\u00e8cnica de Catalunya \u00b7 BarcelonaTech (UPC), Barcelona 08019, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9093-0695","authenticated-orcid":false,"given":"Gerard","family":"Boix-Lemonche","sequence":"additional","affiliation":[{"name":"Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, \rUniversity of Oslo, Oslo 0450 Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1400-1517","authenticated-orcid":false,"given":"Jordi","family":"Orrit-Prat","sequence":"additional","affiliation":[{"name":"Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08243 Manresa, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9468-6725","authenticated-orcid":false,"given":"Ra\u00fcl","family":"Bonet","sequence":"additional","affiliation":[{"name":"Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08243 Manresa, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9630-4778","authenticated-orcid":false,"given":"Jaume","family":"Caro","sequence":"additional","affiliation":[{"name":"Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08243 Manresa, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Microdent Implant System S.L., 08187 Santa Eul\u00e0lia de Ron\u00e7ana, 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Opinion on copper (nano) and colloidal copper (nano) preliminary version of 27\u201328 October 2020 final version of 5 March 2021 SCCS\/162\/2020. 2021."},{"key":"e_1_3_3_51_2","unstructured":"SCCS (Scientific Committee on Consumer Safety). Opinion on the safety of silver (CAS\/EC No. 7440-22-4\/231-131-3) used in cosmetic products preliminary version of 27 March 2024 SCCS\/1665\/24. 2024. 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