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PUBLICATION EXCLUSIVE: How to approach KPro corneal melt with back plate exposure

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Artificial corneas are a useful surgical option in the visual rehabilitation of corneal blindness. The concept of an artificial cornea was first introduced by Guillaume Pellier de Quengsy in 1789, and in 1853, the first successful quartz crystal implantation into the cornea was published. Currently, the most popular and widely used artificial cornea is the Boston keratoprosthesis (KPro).

The indications for the use of an artificial cornea include refractory corneal blindness with a poor prognosis for conventional penetrating keratoplasty such as failed corneal grafts or chemical or thermal injury, autoimmune ocular disorders such as Stevens-Johnson syndrome, toxic epidermal necrolysis, congenital anomalies such as aniridia, herpetic keratitis and pediatric corneal opacities. The spectrum of postoperative complications associated with an artificial cornea include various forms of corneal melt, infection, extrusion of the KPro, secondary glaucoma, endophthalmitis and retroprosthetic membrane.

In this column, I describe the surgical technique of a keyhole anterior lamellar graft combined with cryopreserved amniotic membrane transplantation for corneal melt and 360° partial exposure of the KPro.

Technique

The anesthesia may be monitored anesthesia care or general anesthesia, depending on surgeon and patient preference. KPro corneal melt with back plate exposure requires surgical intervention (Figure 1). A lamellar keratoplasty is required to completely cover the exposed KPro back plate. The corneal melt is almost 360° around the stem of the collar button design of the keratoprosthesis, with exposure of the anterior surface of the titanium back plate (Figure 1). Additionally, there is complete circumferential covering of the stem with tissue debris, giving a white circular appearance to the central region of the KPro (Figure 1).

•    Click here to read the full publication exclusive, Surgical Maneuvers, published in Ocular Surgery News U.S. Edition, October 10, 2016.