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World Cornea Congress VI April 7-9, 2010

Combined Keratoprosthesis Placement, Cataract Extraction, and IOL Implantation: Results Ginny Kullman MD; Kathryn Colby MD, PhD; Helen Lam MD. World Cornea Congress VI April 7-9, 2010. The authors have no financial interest in the subject matter of this poster. Purpose:.

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World Cornea Congress VI April 7-9, 2010

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  1. Combined Keratoprosthesis Placement, Cataract Extraction, and IOL Implantation: ResultsGinny Kullman MD; Kathryn Colby MD, PhD; Helen Lam MD World Cornea Congress VI April 7-9, 2010 The authors have no financial interest in the subject matter of this poster.

  2. Purpose: • To describe the indications, visual acuity, and complications following concurrent Type I Boston Keratoprosthesis (KPro), cataract extraction, and posterior chamber lens placement. Design: • Pilot, retrospective, non-comparative surgical case series

  3. Method: • All patients underwent cataract extraction and posterior chamber IOL implantation through an open-sky technique, followed by placement of a type 1 keratoprosthesis, by a single surgeon (KC).

  4. Following trephination and removal of the host cornea, manual extracapsular cataract extraction is performed via an open-sky technique with placement of a plano intraocular lens.

  5. The pre-assembled keratoprosthesis is sutured into position with interrupted bites using 9.0 nylon suture.

  6. Demographics: • N = 9 eyes of 9 patients (range 4 months to 78 years) • Follow-up ranged from 1 - 28 months

  7. Indications: • Corneal scarring & neovascularization (3) • Neurotrophic keratopathy (2) • Multiple failed grafts (2) • Peters’ anomaly (1) • Lacrimal choriostoma (1)

  8. Indications: Failed corneal graft HZO/ neurotrophic keratopathy Lacrimal choristoma

  9. Results: • Pre-op vision • 20/200 (1); count fingers (3); hand motions (4) • Post-op vision • All patients achieved 20/200 or better vision within 6 weeks of surgery • 5 patients were 20/40 or better

  10. Complications: • Glaucoma • 3/9 eyes – pre-existing glaucoma • 1/3 required shunt placement for glaucoma progression • 3/6 eyes – developed high intraocular pressure • 2/3 – required shunt placement • 1/3 – IOP controlled with topical therapy • YAG capsulotomy • 4/9 eyes – required YAG laser following surgery • 3/4 – posterior capsule opacity • 1/4 – retro-keratoprosthesis membrane • Cystoid Macular Edema • 1/9 eyes – developed CME following surgery that responded to transeptal steroid injection

  11. Conclusion: • Combined Boston KPro, cataract extraction and intraocular lens placement provides rapid visual recovery in patients who are poor candidates for traditional keratoplasty.  • Observed complications were readily managed in this series. 14 mo F; 7 months post KPro triple; s/p lacrimal choristoma excision

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