World cornea congress vi april 7 9 2010
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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:.

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World Cornea Congress VI April 7-9, 2010

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World cornea congress vi april 7 9 2010

Combined Keratoprosthesis Placement, Cataract Extraction, and IOL Implantation: ResultsGinny 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

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

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).


World cornea congress vi april 7 9 2010

  • 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.


World cornea congress vi april 7 9 2010

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


Demographics

Demographics:

  • N = 9 eyes of 9 patients (range 4 months to 78 years)

  • Follow-up ranged from 1 - 28 months


Indications

Indications:

  • Corneal scarring & neovascularization (3)

  • Neurotrophic keratopathy (2)

  • Multiple failed grafts (2)

  • Peters’ anomaly (1)

  • Lacrimal choriostoma (1)


World cornea congress vi april 7 9 2010

Indications:

Failed corneal graft

HZO/ neurotrophic keratopathy

Lacrimal choristoma


Results

Results:

  • Pre-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

Complications:

  • Glaucoma

    • 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


Conclusion

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


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