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L. J. Haddock, E. Leung, A. Berrocal, V. Perez; Posterior Segment Complications of Permanent Keratoprosthesis at the Bascom Palmer Eye Institute. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1141.
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To evaluate the posterior complications that developed in eyes after successful placement of a permanent keratoprosthesis at the Bascom Palmer Eye Institute over the last 17 years and to determine how these complications can limit their visual potential. We will also analyze the success rate of vitreoretinal surgery and management in restoring visual acuity in these patients as compared to those without the prosthesis. We will also compare the complications in adults and children.
In the last 17 years, 25 eyes of 23 patients underwent permanent keratoprosthesis for management of refractory or severe ocular surface disease at the Bascom Palmer Eye Institute. One patient with Stevens-Johnson syndrome (SJS) underwent a Type II through-the-lid KPro, while 24 patients had Boston Type I KPros. Retrospective chart review was done and those patients who developed posterior segment complications were recorded and analyzed for the type of pathology developed, its management, and final outcome.
The posterior segment complications were 5 cases of retinal detachment (20%, some of these were recurrent RDs), 1 case of vitreous hemorrhage (4%), 2 cases of choroidal hemorrhage or effusion (8%), 5 cases of epiretinal membranes (20%), 1 case of posterior vitreous detachment (4%), 1 case of choroidal detachment (4%), and 2 cases of bacterial endophthalmitis (8%). The two cases of endophthalmitis occurred on patients not receiving vancomycin prophylaxis, and one of these patients underwent evisceration. The following procedures were performed on these patients for the management of their posterior complications: 9 cases of pars plana vitrectomy (36%), 3 cases of retinal detachment repair (12%), 2 cases of scleral buckles (8%), 5 cases of membrane peels (20%), 1 case of Avastin injection (4%), 1 case of laser demarcation (4%), 6 cases of endolasers (24%), 1 case of vitreal tap (4%), 2 cases of heleon injection (8%), 1 case of evisceration (4%), and 1 case of enucleation (4%).
Most patients experienced an improvement in vision after the installation of a keratoprosthesis, but post-operative best-corrected visual acuity (BCVA) was limited by posterior segment complications. The management of this complications can be challenging and requiring modified techniques for vitreoretinal surgery. In this study we analyzed those complications in both adults and children and concluded that although these can be successfully repaired they can significantly limit the visual potential of the prosthesis in many patients.
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