Combined Keratoprosthesis Placement, Cataract Extraction, and IOL Implantation: Results Ginny Kullman MD; Kathryn Colby MD, PhD; Helen Lam MDWorld Cornea Congress VIApril 7-9, 2010

The authors have no financial interest in the subject matter of this poster.

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

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).

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.

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

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

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

Indications: Lacrimal choristoma Failed corneal graftHZO/ neurotrophic keratopathy

Results:Pre-op vision20/200 (1); count fingers (3); hand motions (4)Post-op visionAll patients achieved 20/200 or better vision within 6 weeks of surgery5 patients were 20/40 or better

Complications:Glaucoma3/9 eyes pre-existing glaucoma1/3 required shunt placement for glaucoma progression3/6 eyes developed high intraocular pressure2/3 required shunt placement1/3 IOP controlled with topical therapyYAG capsulotomy4/9 eyes required YAG laser following surgery3/4 posterior capsule opacity1/4 retro-keratoprosthesis membraneCystoid Macular Edema1/9 eyes developed CME following surgery that responded to transeptal steroid injection

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