Abstract
Purpose :
To report the long-term clinical outcomes of AlphaCor keratoprosthesis implantation through analysis of complications, device retention, and visual outcomes in eight patients.
Methods :
This is retrospective chart review of eight patients who received AlphaCor keratoprosthesis between 2004 and 2008. Primary data points collected included presence of ocular surface disease (OSD), post-operative complications, time from device implantation to removal, and best corrected visual acuity (BCVA). OSD was defined as aniridia, chemical or thermal injury, herpetic or microbial keratitis, ocular rosacea, stem cell deficiency, and cicatricial conjunctival disorders. Comparisons between both groups were made using the 2-tailed student’s t-Test. P value less than 0.05 was considered statistically significant.
Results :
Device retention rate at 1, 5, and 10 years was 87.5%, 50%, and 12.5% respectively. Device retention was decreased in OSD eyes at 67.8 months compared to 92 months in those without OSD (p = 0.20). Eyes that were able to achieve surface protection with bandage contact lens wear had a longer mean retention time of 128.5 months compared to those that could not at 55.67 months (p = 0.16). Complications included retroprosthetic membrane formation (50%), corneal melt (62.5%), infection (25%), and optic deposits (62.5%). Of the five patients that developed corneal melt around the device, four had OSD. Patients with OSD demonstrated stromal loss sooner postoperatively (51.4 months) compared to the patient without OSD (85 months). Five of the eight patients had the device removed (62.5%). Reasons for removal were stromal melt without associated infection in three patients, melt associated with infection in one patient, and discoloration with poor visual acuity in one patient. Preoperative BCVA ranged from hand motion to 20/100. Four eyes had little change in postoperative BCVA, however Snellen BCVA in the four remaining eyes improved an average of 8.5 lines, with a BCVA range of 20/70 to 20/20 using various contact lenses.
Conclusions :
Patients with OSD who have undergone AlphaCor keratoprosthesis implantation are more likely to develop negative outcomes. Modern treatment options, such as serum tears, recombinant human nerve growth factor, and scleral contact lenses may offer a contemporary solution for these patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.