Transcript Results of the new KPro Triple Procedure: Keratoprosthesis

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


20/200 (1); count fingers (3); hand motions (4)
Post-op vision

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All patients achieved 20/200 or better vision
within 6 weeks of surgery
5 patients were 20/40 or better
Complications:

Glaucoma
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3/9 eyes – pre-existing glaucoma

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3/6 eyes – developed high intraocular pressure

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2/3 – required shunt placement
1/3 – IOP controlled with topical therapy
YAG capsulotomy
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4/9 eyes – required YAG laser following surgery

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1/3 required shunt placement for glaucoma progression
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:


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