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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

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).
slide4

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.

slide5

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)
slide8

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