Boston Type I Keratoprosthesis and Silicone Oil for the Treatment of Hypotony in Prephthisis - PowerPoint PPT Presentation

Boston Type I Keratoprosthesis and Silicone Oil for the Treatment of Hypotony in Prephthisis

Kristiana D. Neff1, William I. Sawyer2, Michael R. Petersen2, Christopher D. Riemann2, Edward J. Holland2

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

• 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 CicatricialPemphigoid

• 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

• Hypotony
• Visually Significant

OR

• Worsening
• Poor visual acuity
• In operative eye:

BCVA ≤ 20/CF

• In fellow eye:

BCVA ≤ 20/400

• Failed cornea

Technique

• 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

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

LP = Light Perception, HM = Hand Motion,

ft = foot, CF = Count Fingers, mo = months

• 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

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

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

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.

Advanced retinal techniques including endoscopic visualization can be applied to a spectrum of diseases in the context of a KPro.

Retinal detachment

Rhegamatogenous

Traction

Vitreous hemorrhage

• Fibrous proliferation
• Aniridic anterior fibrosis syndrome
• Hypotony