Wide-field vitreoretinal surgery in eyes with Boston type 1 keratoprosthesis

This is a report of 3 patients diagnosed with idiopathic macular telangiectasia type 1 (MacTel 1) at Medical Retina Center of the University of Eye Clinic of Genova and then prospectically followed for a mean time of 26 months between 2016 and 2019. It is the first report of patients affected by MacTel 1 treated with dexamethasone (DEX) implant as a first choice of treatment. Aim of our study is to better characterize the disease using a multimodal wide-field imaging and to determine efficacy of DEX implant on MacTel 1 in terms of central macular thickness (CMT) and best-corrected visual acuity (BCVA). MacTel 1 is a rare unilateral disease, characterized by telangiectatic retinal capillaries, cystoid macular edema, and lipid deposition occurring temporal to the fovea. Patients underwent a comprehensive ophthalmic examination, BCVA, swept-source optical coherence tomography (SS-OCT), SS-OCT angiography (SS-OCTA), ultra-widefield (UWF) color, and fluorescein angiography (FA) fundus photograph. All the patients presented monolateral reduced BCVA and macular edema with increased CMT evaluated by SS-OCT. With SS-OCTA, we showed that the telangiectasia-associated vascular changes originate in the deep retinal vascular plexus and as a consequence macular edema and exudation develop causing vision loss. Furthermore, UWF imaging helped us to highlight vascular changes typical of Coats Disease at the far retinal periphery. All the patients were treated with DEX intravitreal implant, showing a decrease in CMT and a stabilization of visual acuity. Due to the recurrent nature of macular edema, patients underwent a mean of 4 DEX implants during the follow-up period. In order to address the clinical features of this uncommon disease avoiding diagnostic errors, it might be important to use a multimodal imaging approach. The anatomical and functional beneficial effects of DEX implant were well evident although transient.

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Time to achieve best postoperative visual acuity following Boston keratoprosthesis surgery

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317483 ◽

2021 ◽

pp. bjophthalmol-2020-317483

Author(s):

Jonathan El-Khoury ◽

Majd Mustafa ◽

Roy Daoud ◽

Mona Harissi-Dagher

Keyword(s):

Visual Acuity ◽

Contributing Factors ◽

Time Duration ◽

Patient Demographics ◽

Snellen Visual Acuity ◽

Boston Type 1 Keratoprosthesis ◽

The Mean ◽

Retroprosthetic Membrane

Background/aimsTo evaluate the time needed for patients with Boston type 1 keratoprosthesis (KPro) to reach their best-corrected visual acuity (BCVA) and all contributing factors.MethodsWe retrospectively reviewed 137 consecutive eyes from 118 patients, measured how long they needed to reach their BCVA and looked at factors that might affect this time duration including patient demographics, ocular comorbidities and postoperative complications.ResultsThe mean follow-up was 5.49 years. The median time to BCVA postoperatively was 6 months, with 47% of patients achieving their BCVA by 3 months. The mean best achieved logMAR visual acuity was 0.71, representing a gain of 6 lines on the Snellen visual acuity chart. Postoperative glaucoma, retroprosthetic membrane (RPM) and endophthalmitis prolonged this duration. We found no correlation between the following factors and time to BCVA: gender, age, indication for KPro surgery, primary versus secondary KPro, number of previous penetrating keratoplasties, previous retinal surgery, intraoperative anterior vitrectomy and preoperative glaucoma.ConclusionIn our retrospective cohort, the majority of subjects reached their BCVA between 3 and 6 months after KPro implantation. This duration was significantly prolonged by the development of postoperative glaucoma, RPM and endophthalmitis.

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Continuous Contact Lens Wear in Boston Type 1 Keratoprosthesis: Why Are We Still Debating?

Eye & Contact Lens Science & Clinical Practice ◽

10.1097/icl.0000000000000790 ◽

2021 ◽

Vol 47 (5) ◽

pp. 233-234

Author(s):

Maria S. Cortina

Keyword(s):

Contact Lens ◽

Continuous Contact ◽

Contact Lens Wear ◽

Boston Type 1 Keratoprosthesis ◽

Lens Wear

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Keratoprostheses in silicone oil-filled eyes: long-term outcomes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312426 ◽

2018 ◽

Vol 103 (6) ◽

pp. 781-788 ◽

Cited By ~ 2

Author(s):

Geetha Iyer ◽

Bhaskar Srinivasan ◽

Shweta Agarwal ◽

Ruchika Pattanaik ◽

Ekta Rishi ◽

...

Keyword(s):

Silicone Oil ◽

Vitreoretinal Surgery ◽

Retrospective Chart Review ◽

Protective Role ◽

Visual Rehabilitation ◽

Two Factors

PurposeTo analyse the functional and anatomical outcomes of different types of keratoprostheses in eyes with retained silicone oil following vitreoretinal surgery.MethodsRetrospective chart review of patients operated with any type of permanent keratoprosthesis (Kpro) in silicone oil-filled eyes between March 2003 and June 2017 were analysed.Results40 silicone oil-filled eyes underwent keratoprostheses, of which 22 were type 1 and 18 were type 2 Kpros (Lucia variant—nine, modified osteo odonto kerato prosthesis (MOOKP)—four, Boston type 2—three and osteoKpro—two) with a mean follow-up of 61.54 , 42.77, 45.25 , 25 and 37 months, respectively. Anatomic retention of the primary Kpro was noted in 33 eyes (82.5%). A best-corrected visual acuity of better than 20/200 and 20/400 was achieved in 26 (65%)+32 (80%) eyes. Retroprosthetic membrane (RPM) was the most common complication noted in 17 eyes (42.5%). Perioptic graft melt was noted in 4 of 22 eyes of the type 1 Kpro (2 (10.5%) without associated ocular surface disorder (OSD)) and in 1 eye each of Boston and Lucia type 2 Kpro. Laminar resorption occurred in one eye each of the MOOKP and OKP groups. Endophthalmitis and glaucoma did not occur in any eye.ConclusionAppropriately chosen keratoprosthesis is a viable option for visual rehabilitation in eyes post vitreoretinal surgery with retained silicone oil-induced keratopathy not amenable to conventional penetrating keratoplasty. Kpro melt among type 1 Kpro did not occur in 89.5% eyes without associated OSD (19 of 22 eyes), despite the lack of aqueous humour and presence of RPM (4 eyes), two factors considered to play a significant role in the causation of sterile melts. Of interest to note was the absence of infection in any of these eyes. The possible protective role of oil from endophthalmitis is interesting, though yet to be ascertained.

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Corneal Surgeries

10.4018/978-1-7998-6937-5.ch013 ◽

2022 ◽

pp. 439-503

Keyword(s):

Excimer Laser ◽

Corneal Transplantation ◽

Previous Infection ◽

Boston Type 1 Keratoprosthesis

This chapter includes corneal surgeries performed in the center such as corneal transplantation (PK, DALK, DSAEK, DMEK) with all possible complications: graft rejections, recurrence of previous diseases, reactivation of previous infection, and other rare complications. Photos of conjunctival limbal autotransplantation, Boston type 1 keratoprosthesis surgery, and corneal tattooing are included as well. Some interesting cases are discussed with management. Several possible complications after excimer laser procedures are also presented.

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