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Only Dropped Kpro…3 Year FU

Only Dropped Kpro…3 Year FU. Dr. Quresh B. Maskati Director Cornea Service Maskati Eye Clinic, Bhatia General Hospital. Mr. B. Kabra…56 Years. Uneventful 2 stage Pintucci Kpro surgery 1 st stage done by dr. Pintucci Buccal mucosa a bit thick Patient had useful vision 6/18 for 2 years.

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Only Dropped Kpro…3 Year FU

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  1. Only Dropped Kpro…3 Year FU Dr. Quresh B. Maskati Director Cornea Service Maskati Eye Clinic, Bhatia General Hospital

  2. Mr. B. Kabra…56 Years • Uneventful 2 stage Pintucci Kpro surgery • 1st stage done by dr. Pintucci • Buccal mucosa a bit thick • Patient had useful vision 6/18 for 2 years

  3. 2 Yrs Post-op.. The Fun Starts • The buccal mucosa starts growing over the kpro; Vision drops. Paradise lost! • I excise the overgrowth – paradise regained. Vision 6/18 • Overgrowth again in 3 months- paradise once more lost • Overgrowth excised with Mitomycin C application. Paradise regained!

  4. I Am Annoyed..Patient Is Financially Drained! • Overgrowth again. Vision drops to light perception. • I decide to cauterize edges of buccal mucosa with heat cautery. • Cautery slips from hand, neatly detaches optic from haptic. • Optic(PMMA cylinder) drops onto retina. • There is 3.5mm hole in cornea through which I can see the optic on retina!

  5. What Can I Do??????? • I call ‘friend’ vitreo-retinal surgeon. He refuses to intervene. Says he has never done this sort of thing before! • I call dr. Pintucci in Rome- he says he has done 200 cases, never had such a complication. • I remember, Dr. Pintucci had done 1st stage- he always implants a spare Kpro in other lid! • I remove 2nd Kpro, safely lying dormant for 2 years from lower lid of other eye

  6. Necessity Is the Mother of Invention…. • I reflect the entire buccal mucosa • I suture the haptic of 2nd kpro through remaining haptic of 1st kpro and patient’s cornea, allowing the 2nd kpro optic to occupy the “hole” in the cornea • I put back the buccal mucosa (after thinning, of course) • I ensure the new optic sticks well out through the 3.5mm hole in the buccal mucosa

  7. Paradise Remains Regained….. • It is now 3 years since the 2nd kpro was implanted. • Patient recovered initially 6/24 vision. • Patient seen last week, vision has dropped to 6metres- he has been on self medication with steroid drops continuously for 3 years! • Fundus clearly visible – 1st kpro still seen; Optic disc shows glaucomatous pallor. • Patient still able to carry out all activities of daily living (ADL).

  8. Moral of the Story…. • Dropped optics of kpro are safe as they have no sharp edges unlike IOLs. • Perhaps they can be safely left in the vitreous. • I pray no one else gets this complication, to confirm the veracity of the above 2 statements!

  9. Thank You for Your Attention!

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