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KH Baratz; The Initial Mayo Clinic Experience With Keratoprosthesis Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4175.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report the clinical experience with the Dohlman-Doane keratoprosthesis at one institution. Methods: Type I or type II (through-the-lid) Dohlman-Doane keratoprostheses were embedded in corneal allograft buttons and implanted into four bilaterally blind patients who were deemed ineligible for standard keratoplasty. Intraoperatively, an Ahmed valve was placed unless a glaucoma shunt was already present. Postoperative regimens included periocular corticosteroid injections, chronic topical antibiotics and medroxyprogesterone 1% solution, and chronic oral doxycycline, vitamin C, and, if necessary, carbonic anhydrase inhibitors. Results: Type I and type II keratoprostheses were implanted in one patient and three patients, respectively. Mean age at the time of surgery was 75 years (range=52-91 yrs.) in the four subjects (3 male, 1 female). Preoperative diagnoses included chemical burn (2 patients), cicatricial pemphigoid (1) and presumed cicatricial pemphigoid (1). Preoperative vision ranged from hand motions to light perception in the operated eye. Best postoperative vision ranged from 20/20 to 20/30 with spectacle correction. Postoperative complications included controlled glaucoma (1 patient), uncontrolled glaucoma with visual field loss (1), lacrimal gland cyst (1), wound leak (2), ptosis (1), and skin retraction (1). Eight additional surgical procedures were required; cyclodectruction (3 procedures in 1 patient), excision of lacrimal gland cyst (1), lamellar patch graft (1), replacement of allograt tissue (1), ptosis repair (1), and repair of skin retraction (1). Mean follow-up was 34 months (range=33-35.5 months). Three patients died during the study period. At the time of death or last follow-up, all patients retained visual acuity 20/30 or better. Conclusion:The Dohlman-Doane keratoprosthesis is a useful device for visual rehabilitation in select high-risk patients with corneal blindness. Despite the frequency of complications requiring further surgery, patients may achieve good long-term visual rehabilitation.
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