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Fatai OLUYADI

Fatai OLUYADI. KERATOPROSTHESIS in EYE FOUNDATION HOSPITAL. Keratoprosthesis is a surgical procedure where a severely damaged or diseased cornea is replaced with an artificial cornea.

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Fatai OLUYADI

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  1. Fatai OLUYADI KERATOPROSTHESIS in EYE FOUNDATION HOSPITAL

  2. Keratoprosthesis is a surgical procedure where a severely damaged or diseased cornea is replaced with an artificial cornea. • Keratoprotheses are made of clear plastic with excellent tissue tolerance and optical properties. They vary in design, size and in the implantation techniques. • The idea of artificial cornea was first proposed in 1789 by French ophthalmologist Guillaume Pellier de Quengsy. • The first reported human KPro surgery with a quartz crystal implant was performed by Nussbaum in 1855 KERATOPROSTHESIS

  3. SINGH WORST KPro • BOSTON Kpro • OSTEO-ODONTO Kpro • ALPHA-COR KPro Keratoprosthesis -types

  4. Multiple graft failure • Stevens-Johnson syndrome • Ocular cicatricialpemphigoid • Ocular burns (acid and alkali, thermal) • and other conditions with poor prognosis with traditional PKP • Procedure of last resort - to give at least navigational vision - not done if BVA both eyes > or= CF INDICATIONS & CONTRAINDICATIONS

  5. STEVEN JOHNSONS SYNDROMES Vascularized cornea Central KPro in a patient with Acid burns 8yrs post-op VA 6/36

  6. Most common postoperative complications in order of decreasing prevalence include: • Retroprosthetic membrane • Kpro Lens Extrusion • Elevated intraocular pressure/glaucoma • Infectious endophthalmitis • Sterile vitritis • Retina detachment (rare) and • Vitreous hemorrhage (rare) COMPLICATIONS

  7. Multicenter Boston KPro Study is the largest published to date with 141 Boston type I keratoprosthesis procedures from 17 surgical sites by 39 different surgeons [. • At an average follow-up of 8.5 months, retention rate of the device was 95%, 57% had BCVA ≥ 20/200. • A large single surgeon series with 57 modern type I Boston KPro procedures from UCLA medical center [16]. At an average follow-up of 17 months, retention rate of the device was 84%, 75% had BCVA ≥ 20/200. Visual outcome

  8. Post-Op visual improvement: after Singh-Worst KProIf the media is clear and IOP under control, patient can start seeing 6 hours after surgery. The visual results may vary anything between 6/9 to simply light perception. The average post-op VA is 6/36. • However, if the media is reasonably clear, a patient is quite happy being able to move around on his own if the health of the optic nerve is not a limiting factor. Prescription glasses also help in better visualization. Most of Singh-Worst KPro patients tend to require around +7.0D sphere. Visual outcome

  9. The Boston Keratoprosthesis (Boston KPro) is a collar button design keratoprosthesis (Kpro) • It is composed of a front plate with a stem, which houses the optical portion of the device, a back plate and a titanium locking c-ring Boston keratoprosthesis

  10. Osteo-odonto-keratoprosthesis (OOKP) (also known as "tooth in eye" procedure. • It includes removal of a tooth from the patient or a donor. After this, a lamina of tissue cut from the tooth is drilled and the hole is fitted with optics. The lamina is grown in the patients' cheek for a period of months and then is implanted upon the eye Osteo-odontokpro (ookp)

  11. Contains a peripheral skirt and a transparent central region. These two parts are connected on a molecular level by an interpenetrating polymer network, made from poly-2-hydroxyethyl methacrylate (pHEMA). • FDA-approved type of synthetic cornea measuring 7.0 mm in diameter and 0.5 mm in thickness. • main advantages of synthetic corneas are that they are biocompatible, and the network between the parts and the device prevents complications that could arise at their interface. Alpha-corkeratoprosthesis

  12. SINGH-WORST KPRO • Designed and developed in collaboration with Dr. Jan Worst in Netherlands and Dr. Daljit Singh in India. • Champagne-Cork Design for better stability. • one piece polycarbonate device • anterior surface has a diameter of 6.0mm • Shaft end diameter 4.5mm. Neck diameter 3.0 mm. • The flange has 8 equidistant holes near the margin.

  13. 4 KPro surgeries done so far since April 2010 • All with Singh-Worst Kpro Lenses obtained from Dr Daljit Singh Amritsar North India • One lost to follow-up • One currently with VA LP • One with VA BCVA 6/36 • Most recent case with BCVA 6/18 Keratoprosthesis at eye foundation hospital

  14. The Most Recent Case: • 33yrs old man • Lost vision in both eyes from acid injury 2years ago • Developed cicatricial cornea lessions with extensive Ankylo- and Symblepharonin both eyes with VA of LP RIGHT EYE LEFT EYE

  15. Had Symblepharon repair with superior and inferior fornix reformation and Singh-Worst Kpro Surgery in the Left eye -July 2012 • BCVA now 6/18 8 DAY POST-OP 1 DAY POST-OP

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