July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Pediatric Keratoprosthesis With Implementation of a Conjunctival Flap: Outcomes, Complications, and Future Directions
Author Affiliations & Notes
  • Faraaz Khan
    Flaum Eye Institute, University of Rochester Medical Center, Pineville, North Carolina, United States
  • Mohammad H Bawany
    University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
  • Mina M Chung
    Flaum Eye Institute, University of Rochester Medical Center, Pineville, North Carolina, United States
  • Kudla M Callais
    Flaum Eye Institute, University of Rochester Medical Center, Pineville, North Carolina, United States
  • James Aquavella
    Flaum Eye Institute, University of Rochester Medical Center, Pineville, North Carolina, United States
  • Footnotes
    Commercial Relationships   Faraaz Khan, None; Mohammad Bawany, None; Mina Chung, None; Kudla Callais, None; James Aquavella, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2218. doi:
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      Faraaz Khan, Mohammad H Bawany, Mina M Chung, Kudla M Callais, James Aquavella; Pediatric Keratoprosthesis With Implementation of a Conjunctival Flap: Outcomes, Complications, and Future Directions. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2218.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : In 2004, surgeons at the Flaum Eye Institute at the University of Rochester performed corneal transplantation using the Boston Keratoprosthesis type 1 (BKPro). One of the more recent changes to the procedure involves the use of a conjunctival flap to completely cover the transplant. The use of a conjunctival flap in keratoprosthesis has yet to gain complete traction, and its impact on outcomes of the BKPro procedure have yet to be fully elucidated. We reported the outcomes and complications following Boston Keratoprosthesis type 1 with a conjunctival flap in the pediatric population

Methods : We performed a retrospective chart review of pediatric patients (<16 years at time of surgery) undergoing KPro implantation with implementation of a conjunctival flap at the Flaum Eye Institute in Rochester, NY, USA. Patients for which there were electronic records available were included in this study. Minimum follow-up time was 6 months. The main outcome measures in this study were visual outcome, device retention, and complications. Demographics and indications for surgery were also gathered.

Results : The BKPro1 with full-thickness conjunctival flap was performed in 17 eyes of 13 patients aged 1 to 230 months (mean 47 months). Out of 17 implantations, 9 were performed as primary corneal procedures, 5 were performed due to histories of failed corneal transplantations. Best corrected visual acuities prior to surgery ranged from no light perception (NLP) to 4/70. Visual acuities at last follow-up (mean: 26 months, range: 6 months to 51 months) improved in 9 eyes, worsened in 4 eyes, and stayed the same in 4 eyes. Post-operative complications included retroprosthetic membrane formation in 13 eyes and retinal detachment in 4 eyes (mean 23 months post-op). BKPro extrusion occurred in 4 eyes, and mean BKPro implant survival time in this study was 24 months

Conclusions : Implementation of a full-thickness conjunctival flap has been shown in this study to lead to low implant extrusion rates and improved visual outcomes in a majority of transplant recipients. This may be due to the structural reinforcement the flap provides or its ability to promote healing of the damaged corneal surface it overlays due to its well-vascularized nature. More outcome data is needed to continue optimizing this procedure and to eventually offer the best outcomes to children with corneal defects

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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