World Cornea Congress VI April 7-9, 2010

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Presentation transcript:

World Cornea Congress VI April 7-9, 2010 Combined Keratoprosthesis Placement, Cataract Extraction, and IOL Implantation: Results Ginny Kullman MD; Kathryn Colby MD, PhD; Helen Lam MD World Cornea Congress VI April 7-9, 2010 The authors have no financial interest in the subject matter of this poster.

Purpose: To describe the indications, visual acuity, and complications following concurrent Type I Boston Keratoprosthesis (KPro), cataract extraction, and posterior chamber lens placement. Design: Pilot, retrospective, non-comparative surgical case series

Method: All patients underwent cataract extraction and posterior chamber IOL implantation through an open-sky technique, followed by placement of a type 1 keratoprosthesis, by a single surgeon (KC).

Following trephination and removal of the host cornea, manual extracapsular cataract extraction is performed via an open-sky technique with placement of a plano intraocular lens.

The pre-assembled keratoprosthesis is sutured into position with interrupted bites using 9.0 nylon suture.

Demographics: N = 9 eyes of 9 patients (range 4 months to 78 years) Follow-up ranged from 1 - 28 months

Indications: Corneal scarring & neovascularization (3) Neurotrophic keratopathy (2) Multiple failed grafts (2) Peters’ anomaly (1) Lacrimal choriostoma (1)

Indications: Failed corneal graft HZO/ neurotrophic keratopathy Lacrimal choristoma

Results: Pre-op vision Post-op vision 20/200 (1); count fingers (3); hand motions (4) Post-op vision All patients achieved 20/200 or better vision within 6 weeks of surgery 5 patients were 20/40 or better

Complications: Glaucoma YAG capsulotomy Cystoid Macular Edema 3/9 eyes – pre-existing glaucoma 1/3 required shunt placement for glaucoma progression 3/6 eyes – developed high intraocular pressure 2/3 – required shunt placement 1/3 – IOP controlled with topical therapy YAG capsulotomy 4/9 eyes – required YAG laser following surgery 3/4 – posterior capsule opacity 1/4 – retro-keratoprosthesis membrane Cystoid Macular Edema 1/9 eyes – developed CME following surgery that responded to transeptal steroid injection

14 mo F; 7 months post KPro triple; s/p lacrimal choristoma excision Conclusion: Combined Boston KPro, cataract extraction and intraocular lens placement provides rapid visual recovery in patients who are poor candidates for traditional keratoplasty. Observed complications were readily managed in this series. 14 mo F; 7 months post KPro triple; s/p lacrimal choristoma excision