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N. R. Benitah, C. B. Westerfeld, A. Hagiwara, S. Mukai; Fundus Imaging in Keratoprosthetic Eyes Using the RetCam. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3311.
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The Boston Keratoprosthesis is the most commonly used artificial cornea in the world with more than 1200 implanted to date. Complications include glaucoma, retinal detachment and choroidal detachment, but the 3 mm opening makes evaluation and documentation of the fundus very difficult. Biomicroscopy with a 90D lens and indirect ophthalmoscopy with a 28D or 30D lens are usually employed with some success. Ancillary tests of optical coherence tomography for macular and optic-disc evaluation and B-scan ultrasonography for posterior and peripheral retinal and choroidal evaluation can be very useful. We have previously used the RetCam II® system to successfully image pediatric eyes with small pupils, and we evaluated this technique in eyes with Boston Keratoprostheses.
All eyes had either type 1 or type 2 Boston Keratoprosthesis. We used the RetCam II® digital, contact, retinal-imaging system with the 80° (E800) and 130° (D1300) lenses to examine the fundus and obtain fundus photographs of these eyes. GenTeal® was used as the coupling agent, and the system was used without removal of the bandage contact lens in type 1 cases.
The system allowed for relatively comfortable examination and photography in the awake patient. In many instances, the view of the fundus was significantly better than on clinical examination. The 80° and 130° lenses were used to obtain the desired magnification and field of view. We obtained fundus photographs of very good quality although reflections and other artifacts were often present. This did not prevent examination and photodocumentation in most cases.
The RetCam II® system is very useful in the examination of the optic disc, retina and choroid in Boston Keratoprosthesis eyes. It extends the currently available examination techniques and tests. In addition, it allows for adequate photography of the fundus including the macula, optic disc and peripheral retina.
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