Ultra-wide field imaging to assess the optic nerve and retina in Boston type I and II keratoprothesis patients

Abstract

Purpose : The ability to view the posterior segment in keratoprosthesis (Kpro) implanted patients is limited. The purpose of this retrospective, observational study was to investigate the use of ultra-wide field (UWF) scanning laser ophthalmoscopy imaging and its utility for serial evaluation of the retina and optic nerve in patients with either a Boston type I or II Kpro.

Methods : A retrospective chart review of patients with Boston type I or II Kpro seen at The Ohio State University Wexner Medical Center between 2009 and 2020 was performed under an IRB-approved protocol. Twenty-eight Kpro patients were identified. Fifteen eyes from 14 patients implanted with a Boston type I or II Kpro underwent UWF imaging (UWFI) as standard of care using the Optos imaging system and were consecutively enrolled into this study. A total of 35 patient visits included UWFI. Images were graded for quality by a single masked reader on a defined 4-point scale (“Poor”, “Fair”, “Good”, or “Very Good”) and assessed for clinical pathology of the retina and optic nerve. Clinical characteristics and examination findings were described using descriptive statistics.

Results : Fourteen of the 15 eyes (93.3%) had a type I Kpro, while one eye (6.7%) had a type II Kpro. UWFI from 35 patient visits were reviewed for quality and clinical pathology. 2.9% of images (1/35) were graded as “poor” and provided no visualization of posterior segment structures. 97.1% of images (34/35) were deemed “fair”, “good”, or “very good” and provided at least some clinical utility. Clinically useful images were obtained on both type I and type II Kpro implanted patients. The optic nerve and macula were both visible in 94.3% of images (33/35). Clinical pathology included glaucoma, macular degeneration, and repaired retinal detachment. In 4 eyes, UWFI was performed serially at multiple visits (range: 3-9 individual visits), allowing for longitudinal follow up (range: 3-46 months).

Conclusions : UWFI provides adequate visualization of the posterior segment in Kpro implanted patients. Importantly, this imaging modality allowed noninvasive longitudinal monitoring of retinal and optic nerve clinical pathology in this select patient population. To the best of our knowledge, this is the first study to report the use of UWFI in a patient implanted with a type II Kpro.

This is a 2021 ARVO Annual Meeting abstract.