Mid-term prognosis of type I Boston keratoprosthesis reimplantation

AimTo examine the mid-term visual and anatomical prognosis of patients who require reimplantation of a second Boston keratoprosthesis type 1 (B-KPro).MethodsRetrospective observational case series of 122 patients (141 eyes) who received a B-KPro at a single institution were reviewed. Eyes that underwent a second B-KPro were included in the study. Primary endpoints were B-KPro retention, final visual acuity 20/200 and loss of light perception. Secondary endpoints included the occurrence of postoperative complications.ResultsSeventeen eyes (12%) required a B-KPro reimplantation. Corneal melt was the most common indication for replacement (88%). Mean follow-up time after the second B-KPro was 4.4±2.1 years. The Kaplan-Meier analysis estimated the second B-KPro retention rate at 79% over 8 years. Retroprosthetic membrane (RPM, 53%) was the most common complication. Forty-one per cent of the eyes suffered from corneal melt following their second B-KPro. One year after the second B-KPro, 47% of the patients retained a vision 20/200. Seven eyes (41.2%) lost light perception, which was secondary to an inoperable retinal detachment in five cases. Four eyes (24%) developed phthisis following inoperable retinal detachment (n=3) or endophthalmitis (n=1).ConclusionB-KPro reimplantation is a potentially sight- and globe-saving procedure for eyes with B-KPro failure, but the prognosis is guarded. B-KPro reimplantation can salvage ambulatory vision in a third of patients while another third of patients progress to loss of light perception. RPM and retinal detachment were important obstacles to visual rehabilitation while recurrent corneal melt was responsible for most cases of anatomical failure.

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Long-term outcomes of Boston keratoprosthesis type I: the Chinese People’s Liberation Army General Hospital experience

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315617 ◽

2021 ◽

pp. bjophthalmol-2019-315617

Author(s):

Li-Qiang Wang ◽

Teng-Yun Wu ◽

Xiao-Niao Chen ◽

Ze-Quan Xu ◽

Min Yang ◽

...

Keyword(s):

General Hospital ◽

Ocular Surface ◽

Retention Rate ◽

Case Series ◽

Type I ◽

Long Term Outcomes ◽

Boston Keratoprosthesis ◽

People's Liberation Army ◽

People’S Liberation Army

PurposeTo report the long-term outcomes of Boston keratoprosthesis type I (B-KPro type I) implantation in the management of severe ocular surface disorders.MethodsRetrospective case series. Patients who underwent B-KPro type I implantation at the People’s Liberation Army General Hospital were enrolled between March 2011 and September 2019. Data regarding visual acuity (VA), B-KPro type I retention and postoperative complications were recorded and analysed.ResultsA total of 103 eyes of 100 patients who underwent B-KPro type I implantation were included. The main indications were chemical burn (59.2%), ocular trauma (25.2%), herpetic keratitis (11.7%) and autoimmune diseases (3.9%). The percentage of eyes with postoperative VA of 10/200 or better was 82.7% at 6 months, 82.8% at 12 months, 77.9% at 2 years, 72.4% at 3 years, 71.1% at 4 years, 69.4% at 5 years, 58.9% at 6 years, 56.8% at 7 years and 42.9% at 8 years. Preoperatively, 8.7% eyes were diagnosed with new-onset glaucoma. Retroprosthetic membrane formation occurred in 19.4% eye. Corneal melting occurred in 18.4% eyes. Sterile vitritis was diagnosed in 4.9% eyes and infectious endophthalmitis in 2.9% eyes. Retinal detachment occurred in 0.9% eyes.ConclusionsIn a Chinese patient group, B-KPro type I is a viable option for treating severe ocular surface disorders in eyes where conventional keratoplasty would have a poor prognosis, especially in patients with chemical and thermal burns. Improved visual outcomes and high retention rate can be achieved and maintained in most cases.

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Impact of type I Boston keratoprosthesis implantation on vision-related quality of life

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310745 ◽

2017 ◽

Vol 102 (7) ◽

pp. 878-881 ◽

Cited By ~ 10

Author(s):

Marcus Ang ◽

Ryan Man ◽

Eva Fenwick ◽

Ecosse Lamoureux ◽

Mark Wilkins

Keyword(s):

Quality Of Life ◽

Effect Size ◽

Retention Rate ◽

Well Being ◽

Type I ◽

Boston Keratoprosthesis ◽

Related Quality ◽

The Impact

AimTo determine the impact of type I Boston keratoprosthesis (KPro) implantation on vision-related quality of life (VRQoL).MethodsProspective study in 33 patients (mean age 56±12 years, 67% male) with bilateral corneal blindness, who underwent a KPro implantation at a single tertiary eye hospital (June 2011–July 2015). VRQoL was evaluated using the Impact of Vision Impairment Questionnaire (IVI) at baseline and at 3–6 months postsurgery, after stabilisation of best-corrected visual acuity (BCVA). Rasch analysis was used to transform the IVI responses into interval-level measures comprising the ‘reading’, ‘mobility’ and ‘emotional’ subscales with effect sizes calculated for pre-post VRQoL scores.ResultsMean preoperative BCVA was counting-fingers at 2 feet in the operated eye (20/240 fellow eye). Preoperative VRQoL scores: −2.27, –2.91 and −3.06 logits for the reading, mobility and emotional subscales, respectively. Device retention rate was 90% over the follow-up period (mean 26±12 months). We observed large gains for reading and mobility of 1.92 logits (effect size 0.88), and 2.64 logits (effect size 0.89) respectively, with a moderate gain in the emotional subscale of 2.11 logits (effect size 0.59). These improvements did not vary significantly with BCVA on multivariate analysis (all p>0.05).ConclusionWe observed a differential short-term improvement to VRQoL after KPro implantation with a significant impact on emotional well-being, which may not be fully explained by visual improvement alone. Further studies are required to confirm if these improvements in VRQoL are sustained in the long-term and are generalisable to other populations.

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Intravitreal ranibizumab versus laser photocoagulation for retinopathy of prematurity: efficacy, anatomical outcomes and safety

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312272 ◽

2018 ◽

Vol 103 (9) ◽

pp. 1332-1336 ◽

Cited By ~ 2

Author(s):

Hyun Goo Kang ◽

Eun Young Choi ◽

Suk Ho Byeon ◽

Sung Soo Kim ◽

Hyoung Jun Koh ◽

...

Keyword(s):

Retinal Detachment ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Case Series ◽

Therapeutic Effects ◽

Type I ◽

Intravitreal Ranibizumab ◽

Retrospective Case ◽

Major Complications ◽

Anatomical Outcomes

Background/AimsTo compare the efficacy, anatomical outcomes and complications of intravitreal ranibizumab with those of laser photocoagulation for retinopathy of prematurity (ROP).MethodsThis is a retrospective case series of 314 eyes from 165 infants diagnosed with type I ROP and treated with either laser photocoagulation (161 eyes) or intravitreal ranibizumab (0.25 mg/0.025 mL) injection (153 eyes) between January 2006 and December 2016 in a tertiary referral-based hospital. The main outcome was the rate of recurrence requiring additional treatment. Secondary outcomes included the incidence of major complications and final refractive error.ResultsThe mean follow-up was 36.3±31.9 months. Recurrences requiring further intervention were noted in 22 (13.7%) laser-treated and 15 (9.8%) ranibizumab-treated eyes (p=0.196). Retinal detachment (8 vs 1, p=0.037) and macular dragging (7 vs 1, p=0.039) were observed in the laser-treated and injection-treated groups, respectively, but no systemic or neurodevelopmental adverse events were reported. In the ranibizumab group, 95.6% showed fully vascularised retinas. Multivariate analyses revealed that birth weight (OR 0.993, p=0.023) and higher ROP stage (OR 11.222, p=0.008) influenced the incidence of major complications.ConclusionIntravitreal ranibizumab for ROP appears to achieve similar therapeutic effects than did laser photocoagulation, but with fewer surgical complications such as retinal detachment or macular dragging.

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One-year results and safety of femtosecond arcuate incisions for high post-keratoplasty astigmatism treatment: time to rethink the procedure?

10.21203/rs.3.rs-182458/v1 ◽

2021 ◽

Author(s):

Sergio Kwitko ◽

Bruno Schneider de Araujo ◽

Felipe Pigozzi Cabral ◽

Nessana Neubauer

Keyword(s):

Visual Acuity ◽

Complication Rate ◽

Treatment Time ◽

Treatment Options ◽

Case Series ◽

Limiting Factor ◽

Visual Rehabilitation ◽

Astigmatism Correction ◽

One Year ◽

High Degree

Abstract Background/Aims High astigmatism after keratoplasty is the main limiting factor for visual rehabilitation. Among its treatment options the arcuate keratotomy (AK) with the femtosecond laser stands out for its perfection and versatility of the incision making. We designed a study to evaluate the results and safety of femtosecond arcuate keratotomy (femto-AK) in the treatment of high astigmatism after keratoplasty.Methods A prospective interventional cohort study. We enrolled 17 eyes with high degree of irregular astigmatism, scheduled for Femto-AK. IntraLase FS was used to perform arcuate incisions 1.00 mm inside the graft. Patients’ uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BDCVA), and astigmatic change were recorded and followed up to one year after surgery.Results Despite overall improvement in corneal cylinder and visual acuity in one-year follow-up, there was a 52.9% complication rate. Cylinder overcorrection occurred in 6 cases (35.3%) that was managed with compressive sutures; microperforation occurred in two cases (11.7%); and endothelial rejection in one case (5.9%).Conclusion The predictability of astigmatism correction was variable in reducing postkeratoplasty astigmatism and high complication rate was found in our case series. New nomograms and improvements in technique need to be developed in order to reduce the incidence of overcorrections.

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Surgical outcomes of minimally invasive vitrectomy surgery in Eales’ disease

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i2.8710 ◽

2013 ◽

Vol 5 (2) ◽

pp. 182-189

Author(s):

S Khanduja ◽

S Gupta ◽

S Sinha ◽

Pradeep Venkatesh ◽

R Vohra ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Surgical Outcomes ◽

Case Series ◽

Vitreous Hemorrhage ◽

Neovascular Glaucoma ◽

Retinal Breaks ◽

Eales Disease ◽

23 Gauge ◽

One Year

Introduction: The results of surgical outcomes of 20 gauge pars plana vitrectomy in Eales’ disease are available in the scientific literature. However, all these studies have been done using the 20 gauge vitrectomy systems and most studies have been conducted in a retrospective manner. Objective: To evaluate the outcomes and safety of 23 gauge vitrectomy in complications of Eales’ disease. Materials and methods: Study design: Consecutive interventional case series. Participants: Seventy-six eyes of 72 nonconsecutive patients undergoing 23-gauge vitrectomy for complications of Eales’ disease were enrolled. The participants were followed up for a minimum of one year. Intervention: The participants underwent a complete demographic, medical and ophthalmic evaluation. A 23-gauge vitrectomy was performed. Endotamponade was used when necessary. Perioperative and postoperative events were recorded. Primary outcome measures were visual acuity and complications arising due to surgery. Results: Indication for surgery was non-clearing vitreous hemorrhage in 89.4% (68/76) and secondary retinal detachment in 10.6% (8). Visual acuity improved from Log Mar 1.80 ± 0.19 units preoperatively to Log Mar 0.47±0.59. Best-corrected visual acuity equivalent to Snellen 6/9 was achieved in 77. 6% of eyes. . Surgical failure was seen in 6.5% cases. Four cases were lost due to progression to neovascular glaucoma and 1 case was lost to severe residual retinal detachment. Iatrogenic portside retinal breaks occurred in 3.9% (3), post-vitrectomy retinal detachment 2.6% ( 2), hypotony 1.3% (1) and cataract in 38.1% (28) cases. Conclusion: 23-gauge sutureless vitrectomy in patients with Eales’ disease is a safe and effective technique with acceptable level of risk and complications. Nepal J Ophthalmol 2013; 5(10): 182-189 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8710

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Double Retinal Tamponade for Treatment of Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy and Inferior Breaks

Journal of Ophthalmology ◽

10.1155/2020/6938627 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Mohamed Farouk Abdelkader ◽

Shaaban Abd-Elhamid Mehany Elwan ◽

Ahmed Shawkat Abdelhalim

Keyword(s):

Retinal Detachment ◽

Proliferative Vitreoretinopathy ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Short Term ◽

Retinal Breaks ◽

Case Series Study ◽

Retinal Reattachment ◽

Simultaneous Use ◽

One Year

Purpose. To evaluate the efficacy and safety of the simultaneous use of short-term perfluoro-n-octane (PFO) with perfluoropropane (C3F8) gas to achieve retinal reattachment in eyes with rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C and multiple retinal breaks including inferior breaks. Design. This is a prospective interventional case series study. Patients and Methods. The study was a prospective noncomparative interventional study. It included 30 eyes of 30 patients who had RRD with PVR grade C and multiple retinal breaks including inferior tears attending the vitreoretinal unit of Minia University Hospital, Egypt. The mean age was 50.2 ± 10.63 years; 18 patients were females and 12 were males. Combined phacoemulsification and 23 G pars plana vitrectomy (PPV) with double retinal tamponade by C3F8 and PFO were done, and PFO was removed in 10–14 days. The patients were followed up for one year. The primary outcome was to achieve successful retinal reattachment, and the secondary outcomes were visual improvement and occurrence of complications. Results. Successful retinal reattachment was obtained in 28 eyes out of 30 (93.3%), and 2 eyes (6.7%) had recurrent RD. Best-corrected distance visual acuity (BCDVA) in logMAR was significantly improved from baseline 1.74 ± 0.05 to 0.93 ± 0.04, 0.82 ± 0.05, 0.80 ± 0.07, and 0.73 ± 0.055 at follow-up visits 3, 6, and 9 months and one year, respectively ( P ≤ 0.001 ). There were no serious ocular complications recorded. Conclusions. The results of this study indicated that primary vitrectomy with simultaneous use of both C3F8 and short-term PFO as retinal tamponades was effective and safe in the management of complex cases of RRD with PVR grade C and inferior breaks. This trial is registered with NCT04168255.

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Type I Boston keratoprosthesis with cataract extraction and intraocular lens placement for visual rehabilitation of herpes zoster ophthalmicus: the "KPro Triple"

British Journal of Ophthalmology ◽

10.1136/bjo.2008.146415 ◽

2008 ◽

Vol 93 (1) ◽

pp. 119-119 ◽

Cited By ~ 13

Author(s):

A Todani ◽

P Gupta ◽

K Colby

Keyword(s):

Herpes Zoster ◽

Intraocular Lens ◽

Cataract Extraction ◽

Type I ◽

Herpes Zoster Ophthalmicus ◽

Visual Rehabilitation ◽

Boston Keratoprosthesis

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Vitrectomy with air tamponade and cryotherapy for retinal detachment repair without perfluorocarbon use: A UK 12-month prospective case series

European Journal of Ophthalmology ◽

10.1177/1120672120978884 ◽

2020 ◽

pp. 112067212097888

Author(s):

George Moussa ◽

Namita Mathews ◽

Osama Makhzoum ◽

Dong Y Park

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Inclusion Criteria ◽

Visual Rehabilitation ◽

Lattice Degeneration ◽

Pars Plana ◽

Air Tamponade ◽

Prospective Case Series

Introduction: Rhegmatogenous retinal detachment (RRD) is commonly managed by pars plana vitrectomy (PPV). Gas tamponade has significant clinical and quality of life factors that affect the patient. Using shorter acting air tamponade, intuitively leads to surgical concern for higher rate of primary detachment. To circumvent this, surgeons advocate the use of perfluorocarbon to maximise sub-retinal-fluid drainage when using air tamponade and/or avoid using cryotherapy due to longer duration for scar formation relative to laser. These steps are a deviation from traditional technique for otherwise routine primary RRD repair and discourages popularisation of using air tamponade despite the benefits to patients. Method: Prospective 12-month, single centre, single surgeon, consecutive study from January to December 2019. Inclusion criteria was as per based on the pneumatic retinopexy versus vitrectomy for retinal detachment: (i) single retinal break or group of breaks, no larger than 1-clock-hour (30°), in detached retina; (ii) all breaks in detached retina lie above the 8 to 4 o’clock meridian; and (iii) breaks or lattice degeneration in attached retina at any location. We excluded PVR formation and RRD in the inferior 4 o’clock hours. Results: We report primary and final success rate of 96% and 100%, respectively in 23 eyes (22 macular-on and one macular-off) with RRD eyes in a 12-month period. Cryopexy was utilised in 65% patients and in isolation in 23% with no perfluorocarbon use in all eyes. Conclusion: We show cryotherapy can be used safely in AT-RRD without PFCL in RRD fulfilling PIVOT trial criteria with minimal cataract formation and IOP spikes and faster post-operative visual rehabilitation.

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