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S. Rashid, G. Kullman, H. Y. Lam, K. Colby; Concurrent Cataract Extraction and Intraocular Lens Placement With the Type I Boston Keratoprosthesis: The K-Pro Triple. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1139.
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The purpose of our study is to discuss the surgical technique and outcomes of case series of seven patients who underwent cataract extraction, plano intraocular lens placement and aphakic Type I Boston keratoprosthesis (the "K-Pro Triple") procedure.
Charts of 7 patients (7 eyes) who underwent K-Pro triple procedure at MEEI from May 2007 to May 2009, were retrospectively reviewed for indications of surgery, demographics, pre- and post- operative visual acuity and intraocular pressure, and intraoperative and postoperative complications.For each patient, an aphakic Boston keratoprosthesis was assembled in an 8.5 mm donor button. The host cornea was trephined using an 8.0mm vacuum trephine and removed with corneal scissors. The cataract was removed using an open-sky extracapsular technique and plano 3- piece acrylic IOL inserted into the capsular bag. The pre-assembled K-Pro was then sutured into position using 9-0 sutures.
Pre-operative characteristics: There were 3 females (42.8 %) and 4 males (57.1%), with age range 4 to 79 years. Preoperative visual acuity (VA) ranged from 20/200 (n=1; 14.2%), counting fingers (n=4, 57.1%) to hand motions (HM) (n=2, 28.6%). The indications for triple K-Pro was herpes zoster neurotrophic keratitis (n=2), keratoconus with corneal neovascularization (n=1), Peter’s anomaly (n=1), corneal ulceration presumably secondary to chronic steroid use (n=1), and corneal neovascularization of unclear etiology (n=2). Three patients (42.9%) had history of well controlled glaucoma.Post-operative course and complications: Follow- up ranged from 1.5 to 22 months. VA at last follow-up was 20/30 (n=1), 20/50 (n=2), 20/60 (n=2), 20/89 (n=1) and 20/200 (n=1 due to post-op CME).. Complications included worsened glaucoma (n=2, both with prior history of glaucoma, controlled with meds and or surgery), retroprosthesis membrane (n=2), posterior capsular opacification (n=1) and mild tearing and pain (n=1).
We recommend the K-Pro triple procedure as it has a favorable outcome with most eyes attaining VA of 20/60 or better, and alleviates the need of reoperation for cataract extraction. The complication rate was small with only a small number of eyes developing exacerbation of pre-existing glaucoma and retroprosthesis membrane, both of which were readily managed.
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