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Mark Krakauer, Shivani Gupta, Asim V. Farooq, Jose De la Cruz, Maria S. Cortina, Peter Setabutr; Oculoplastic Considerations In Keratoprosthesis Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):342.
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To characterize the frequency, nature, and outcomes of oculoplastic referrals and procedures in patients undergoing Boston type 1 keratoprosthesis (KPro) implantation.
A retrospective review was conducted of all KPro procedures performed at the University of Illinois at Chicago between December 21, 2006 and September 23, 2010, with a minimum of 10 weeks of follow-up. Patient medical records were reviewed with respect to demographics, diagnosis, and indications and outcomes of oculoplastic and KPro surgeries.
A total of 64 Boston type 1 keratoprostheses were implanted in 61 eyes of 59 patients during the study time period. 21 eyes in 20 patients were referred for oculoplastics evaluation. Chemical burn (8 eyes) was the most common etiology of corneal disease requiring KPro. Patients were subdivided based on whether their periocular issue was related to abnormal eyelid anatomy or ocular surface disease, or both. 8 out of 21 had eyelid abnormalities, 7 had issues with their ocular surface, and 6 had both ocular surface disease and eyelid abnormalities. 17 eyes underwent an oculoplastics procedure. The most common initial procedure was tarsorrhaphy with or without transposition of the tarsal plate (10), followed by ptosis repair (3), lid tightening (3), lower lid retractor recession (2), lid lesion excision (2), symblepharolysis with mucous membrane graft prior to KPro implantation (1), and upper lid retractor recession (1), with some patients having more than one procedure performed initially. At a minimum of ten weeks follow-up, 15 of 17 eyes that had an oculoplastics procedure maintained a KPro, while 2 did not.
This series demonstrates a high incidence of oculoplastics procedures in KPro patients; ocular surface disease and eyelid abnormalities were the two main factors that threatened KPro stability and retention of the contact lens, which is crucial in preventing extrusion. The most common oculoplastics procedure was tarsorrhaphy; early recognition and treatment of exposure and contact lens retention issues, in some cases even before KPro implantation, can be critical in avoiding corneal melting and extrusion. Early treatment of ptosis, as well, can help maximize visual outcomes.
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