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Ellen Shorter, Charlotte Joslin, Timothy McMahon, Jose De la Cruz, Maria Cortina; Bandage CL fitting characteristics and complications in patients with Boston Type I keratoprosthesis surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3464.
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To describe bandage contact lens fitting characteristics and complications in patients that have undergone Boston Type I keratoprosthesis surgery at the University of Illinois at Chicago (UIC). Proper bandage lens fit is critical to lens retention and is necessary to protect the ocular surface from complications related to corneal desiccation.
Medical records data was abstracted and analyzed among patients who underwent Boston Type I keratoprosthesis surgery at UIC between January 1, 2007 and June 1, 2012.
76 eyes of 71 patients were identified who underwent surgery at UIC with a minimum of 6 months of follow-up. Pre-surgical indications included non-inflammatory (38 eyes), limbal stem cell deficiency (LSCD) (20 eyes), chemical/thermal burn (14 eyes) and autoimmune disease (4 eyes). Forty-three percent achieved visual acuity of 20/200 or better compared to 3% before surgery. Bandage lens loss occurred between visits in 38% of patients and deposits were noted in 20%. Lens loss was more common in the LSCD and chemical burn group while lens deposits were most common in the autoimmune group. The final bandage lens incorporated a power change in 38% while 30% remained in the same fitting parameters as the initial post-surgical lens. Sagittal depth was increased by decreasing the base curve or increasing the diameter in 37%. Frequent replacement silicone hydrogel lenses were used to re-fit 22% of patients. Hybrid contact lenses were fit in 7% of patients due to frequent lens loss or visually significant deposits despite refitting. Of the eyes with corneal melt requiring repeat keratoprosthesis or keratoprosthesis removal, 62% had problems with bandage lens loss. Corneal melt occurred in 8% of the non-inflammatory group, 35% in the LSCD group, 21% in the chemical and thermal burn group and in no eyes in the autoimmune group. At last follow-up, 91% retained a keratoprosthesis device.
Well-fit bandage contact lenses are essential to lens retention and success in patients who have undergone Boston Type I keratoprosthesis surgery. Contact lens over-refraction is important in all patients as best-corrected vision improved with a refractive power change in 38% of our patients.
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