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Alice Zhu, Joseph J.K. Ma; Contralateral Eye Comparison in of two different types of keratoprostheses in setting of buphthalmos and multiple corneal transplant failures: optical quality, implications and critical lessons. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3740.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the potential optical quality of a lamellar keratoprosthesis device and to assess the ability of this device to visual rehabilitation in complex corneal and anterior segment disease
Part 1: Diseased corneal tissue with edema from non-functioning corneal endothelium was removed using a femtosecond laser. 100um, 200um, 300um and 400um of tissue was placed behind a lamellar keratoprosthesis device to determine potential optical quality using optical bench techniques and wavefront aberrometry (WA) Part 2: A case review of a patient with multiple corneal transplant failures and multiple glaucoma procedures OU with contralateral keratoprostheses of two different types was performed.
Part 1: Optical quality decreases with increasing diseased corneal tissue thickness. This decrease in optical quality as measured by WA appears to be non-linear. The subjective visual quality of the lamellar device with 100um of residual tissue is significantly different from other thicknesses. Illumination through tissue is significant at 100um vs 400um (p<0.01) Part 2: The patient's corrected acuity (he is aphakic OU) was 20/400 in the eye with a penetrating keratoprosthesis (limited by congenital glaucoma). His acuity was 20/100+1 (improved from HM) in the eye with the lamellar keratoprosthesis with 280um of residual edematous corneal tissue. Total corneal power was estimated using anterior segment OCT and a modification of the lamellar keratoprosthesis was performed to better match the high keratometry due to buphthalmos from congenital glaucoma. The patient has noted a significant improvement in the quality of life with the implantation of his lamellar keratoprosthesis although he may not be at his best visual potential.
Although optical quality is improved with less residual corneal tissue in a lamellar keratoprosthesis, residual tissue may still allow for very functional vision and a significant improvement in the quality of life for these complex corneal patients. The concept of a lamellar keratoprosthesis that does not necessarily unlock the full optical potential of the eye, but achieves a functional improvement in acuity with a potentially lower risk may be a potentially new paradigm in keratoprosthesis surgery. Further follow-up is necessary to assess the long term results.
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