Keratoprothesis Surgery and Patient Care
Surgery information for physicians
- Standard preoperative medical assessment
- General anesthesia or MIVA
- Antibiotics IV recommended at the time of surgery, e.g., cefazolin 1.0 g., if no allergy.
- The surgery time is usually about an hour and a half.
- Boston Keratoprosthesis surgery is readily performed by ophthalmologists with experience in corneal surgery.
The patient should be seen the following day, after one week, two weeks, one month, and every two months for the first year, and then every three to four months. Modify the schedule if problems arise.
Postoperative medication may include Polytrim™ eventually, once daily. Prednisolone acetate 1% as needed. If pressure problems appear, steroids may be eliminated but the antibiotics should be used for life on a daily basis. Impress upon the patient the importance of compliance. Compounded vancomycin drops (14mg/ml) once daily may be added for safety in autoimmune disease, chemical burns or in monocular patients.
Soft contact lens should be worn around the clock on a long-term basis. The lens is very protective of the corneal tissue hydration. If lost, it should be replaced. Colored contact lenses can also be used to enhance the esthetic appearance. Your contact lens department may provide assistance.
Complications that arose early in the development of the device have now been virtually eliminated.
- Inflammmation can be an issue for eyes that have undergone many surgical procedures. In addition to topical steroids, occasional peribulbar injections of 40 mg of triamcinolone may be necessary.
- Any retroprosthesis membrane can be opened with a YAG laser as long as no blood vessels have entered.
- Vascularized membranes are rare but may require reoperation.
- A sudden vitritis can form rarely with drastic reduction of vision. If there is no accompanying redness or pain, the vitritis is most likely sterile and can be treated with peribulbar triamcinolone and prophylactic antibiotics only. They always clear up.
- Bacterial endophthalmitis is fortunately very rare in the graft failure group as long as the prophylactic antibiotics regimen is followed.
- Glaucoma is common in patients needing the Boston Keratoprothesis and may get worse postoperatively. Standard drops are usually effective since they readily diffuse into the eye. Systemic carbonic anhydrase inhibitors have the expected effect. Finally, a glaucoma shunt may be resorted to in severe cases.
If necessary, the procedure is reversible back to a standard corneal graft or can be repeated.
Results of the Boston Keratoprothesis
The Boston Keratoprosthesis has excellent long-term stability and safety. It is also known for having excellent optics. (Insert graphs and photos)
The following graph illustrates the retention rate of patients who receive the Boston Keratoprosthesis.
Autoimmune diseases (Pemphigoid, Stevens Johnson Syndrome, severe connective tissue diseases) require a somewhat different approach.
Keratoprosthesis still carries a somewhat greater burden post-operatively than standard keratoplasty. Successful outcome requires patient compliance, regular follow-up, and standard demands on physician time. However, in cases where further keratoplasty appears futile, keratoprosthesis can be most rewarding.
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