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Boston Type I Keratoprosthesis and Silicone Oil for the Treatment of Hypotony in Prephthisis

Boston Type I Keratoprosthesis and Silicone Oil for the Treatment of Hypotony in Prephthisis. Kristiana D. Neff 1 , William I. Sawyer 2 , Michael R. Petersen 2 , Christopher D. Riemann 2 , Edward J. Holland 2. The authors have no financial interest in the subject matter of this poster.

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Boston Type I Keratoprosthesis and Silicone Oil for the Treatment of Hypotony in Prephthisis

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  1. Boston Type I Keratoprosthesis and Silicone Oil for the Treatment of Hypotony in Prephthisis Kristiana D. Neff1, William I. Sawyer2, Michael R. Petersen2, Christopher D. Riemann2, Edward J. Holland2 The authors have no financial interest in the subject matter of this poster. 1 University of South Carolina 2 Cincinnati Eye Institute, University of Cincinnati

  2. Boston Type I Keratoprosthesis • Excellent option for high risk corneal grafts • Immunologic rejection • Multiple graft failures from rejection • Stromal neovascularization • Endothelial decompensation • Tube shunts • Aniridic intraocular lens • Severe ocular surface disease • Stevens-Johnson Syndrome • Chemical burns • Ocular CicatricialPemphigoid

  3. Purpose • To report the use of Boston Type I Keratoprosthesis (KPro) in combination with silicone oil for treatment of hypotony in prephthisical eyes • To our knowledge, this is the first report of this technique

  4. Inclusion Criteria • Hypotony • Visually Significant OR • Worsening • Poor visual acuity • In operative eye: BCVA ≤ 20/CF • In fellow eye: BCVA ≤ 20/400 • Failed cornea

  5. Study Design Technique • Retrospective, interventional case series • 5 eyes of 5 patients • Outcomes measured: • Preoperative and Postoperative Snellen VA • Intraocular Pressure by digital palpation • Complications • Aphakic Boston Type I KPro implanted and vitreous cavity filled with 5,000 centistoke silicone oil • Advanced vitreoretinal techniques applied including endoscopic visualization for concurrent disease

  6. Patient Demographics PKP = Penetrating Keratoplasty, PDR = Proliferative Diabetic Retinopathy, TRD = Traction Retinal Detachment, ERM = Epiretinal Membrane, RD = Retinal Detachment, PPV = Pars Plana Vitrectomy, PRP = Panretinal Photocoagulation, IOL = Intraocular Lens

  7. LP = Light Perception, HM = Hand Motion, ft = foot, CF = Count Fingers, mo = months

  8. Results • Vision remained stable in all eyes • 4 of 5 eyes (80%) showed improvement in visual acuity • Intraocular pressure improved in all cases • Average Preoperative IOP = 5.8 mmHg • Average Postoperative IOP = 15 mmHg • No intraoperative complications were noted • Long-term silicone oil did not result in extrusion of KPro in any of these cases

  9. Postoperative Complications • 1 eye developed stromal thinning of the donor cornea requiring lamellar patch graft for stabilization • 2 eyes developed epiretinal membranes

  10. Postoperative Complications • 4 eyes (80%) developed retroprosthetic membranes • 2 cases were observed • 2 cases underwent Nd:YAG laser • No case required surgical membrane peel

  11. Conclusions Boston Type I KPro in combination with placement of silicone oil can be a treatment for hypotony in prephthisical eyes. Retroprosthetic membranes can be managed with laser and, if needed, surgical excision.

  12. Conclusions Advanced retinal techniques including endoscopic visualization can be applied to a spectrum of diseases in the context of a KPro. Retinal detachment Rhegamatogenous Traction Vitreous hemorrhage • Fibrous proliferation • Aniridic anterior fibrosis syndrome • Hypotony

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