Boston Type I Keratoprosthesis and Silicone Oil for the Treatment of Hypotony in Prephthisis Kristiana D. Neff 1, William I. Sawyer 2, Michael R. Petersen 2, Christopher D. Riemann 2, Edward J. Holland 2 The authors have no financial interest in the subject matter of this poster. 1 University of South Carolina 2 Cincinnati Eye Institute, University of Cincinnati

Boston Type I Keratoprosthesis Excellent option for high risk corneal grafts – Immunologic rejection Multiple graft failures from rejection Stromal neovascularization – Endothelial decompensation Tube shunts Aniridic intraocular lens – Severe ocular surface disease Stevens-Johnson Syndrome Chemical burns Ocular Cicatricial Pemphigoid

Purpose To report the use of Boston Type I Keratoprosthesis (KPro) in combination with silicone oil for treatment of hypotony in prephthisical eyes To our knowledge, this is the first report of this technique

Inclusion Criteria Hypotony – Visually Significant OR – Worsening Poor visual acuity – In operative eye: BCVA ≤ 20/CF – In fellow eye: BCVA ≤ 20/400 Failed cornea

Study Design Retrospective, interventional case series – 5 eyes of 5 patients Outcomes measured: – Preoperative and Postoperative Snellen VA – Intraocular Pressure by digital palpation – Complications Aphakic Boston Type I KPro implanted and vitreous cavity filled with 5,000 centistoke silicone oil – Advanced vitreoretinal techniques applied including endoscopic visualization for concurrent disease Technique

Patient Demographics GenderAgePreoperative DiagnosisComorbid Conditions Concurrent Procedures Female38Chronic Herpetic Keratouveitis Failed PKP, PDR, TRD Complex RD repair, PRP, IOL explant Male53Aniridic Fibrosis Syndrome Failed PKP, ERM, TRD Complex RD repair, PRP, Membranectomy Male29Aniridic Fibrosis Syndrome Failed PKP None Female57Aniridic Fibrosis Syndrome Failed PKP, ERM, Complex RD Complex RD repair, PRP, Membranectomy Female67Aniridic Fibrosis Syndrome Failed PKP, Retroprosthetic membrane Retrocorneal membrane removal, PRP, Membranectomy PKP = Penetrating Keratoplasty, PDR = Proliferative Diabetic Retinopathy, TRD = Traction Retinal Detachment, ERM = Epiretinal Membrane, RD = Retinal Detachment, PPV = Pars Plana Vitrectomy, PRP = Panretinal Photocoagulation, IOL = Intraocular Lens

Preop Visual Acuity Postoperative Visual Acuity Visual Acuity at Last Visit Total Follow Up Time (months) 1 Month3 Months6 Months1 Year LP HM 1 ftCF 2 ftCF 1 ftN/ACF 1 ft8 HM 1 ft 20/400CF 4 ftCF 3 ftCF 1 ftCF 2 ft29 HM 1 ft 20/400HM 1 ftCF 6 ft 11 HM 1 ft CF 2 ftCF 1 ftHM 1 ft 12 CF 3 ft 20/400 20/60053 Average postoperative follow up = 22.6 months LP = Light Perception, HM = Hand Motion, ft = foot, CF = Count Fingers, mo = months

Results Vision remained stable in all eyes – 4 of 5 eyes (80%) showed improvement in visual acuity Intraocular pressure improved in all cases – Average Preoperative IOP = 5.8 mmHg – Average Postoperative IOP = 15 mmHg No intraoperative complications were noted Long-term silicone oil did not result in extrusion of KPro in any of these cases

Postoperative Complications 1 eye developed stromal thinning of the donor cornea requiring lamellar patch graft for stabilization 2 eyes developed epiretinal membranes

Postoperative Complications – 4 eyes (80%) developed retroprosthetic membranes 2 cases were observed 2 cases underwent Nd:YAG laser No case required surgical membrane peel

Conclusions Boston Type I KPro in combination with placement of silicone oil can be a treatment for hypotony in prephthisical eyes. Retroprosthetic membranes can be managed with laser and, if needed, surgical excision.

Conclusions Advanced retinal techniques including endoscopic visualization can be applied to a spectrum of diseases in the context of a KPro. Fibrous proliferation Aniridic anterior fibrosis syndrome Hypotony Retinal detachment −Rhegamatogenous −Traction Vitreous hemorrhage