Contralateral Eye Comparison-2 Kpros in Buphthalmos With Multiple Transplant Failures: Optical Quality, Implications, and Critical Lessons
Narrative Responses:
Purpose
To assess the potential optical quality (OQ) of a lamellar-keratoprosthesis (L-KPRO) device and to assess the ability of this device for visual rehabilitation in complex corneal and anterior segment disease
Methods
Part1: Diseased edematous corneal tissue was removed using a femtosecond laser. 100um (A), 200um(B), 300um(C) and 400um(D) of tissue was placed behind a L-KPRO device to mimic residual corneal tissue (RCT) and determine potential optical quality using optical bench techniques and wavefront aberrometry (WA) compared to no RCT.
Part2: A case review of a patient with multiple corneal transplant failures and multiple glaucoma procedures OU with contralateral KPROs of two different types was performed.
Results
Part1:OQ decreases w/increasing RCT. This decrease appears non-linear. The subjective visual quality of L-KPRO w/RCT A appears to be significantly more functional than B, C or D. Projection through tissue is significantly different for A vs D (p<0.01)
Part2: BSCVa:20/400 in eye w/penetrating KPRO (limit/congenital glaucoma). BSCVa:20/100+1 (from HM) in eye w/ L-KPRO w/280um RCT. Total corneal power estimated w/anterior segment OCT and surgical modification of L-KPRO was performed to better match high keratometry from buphthalmos. The patient has noted significant improvement in quality of life (QoL) w/his L-KPRO, although he may not be at his best visual potential.
Conclusion
AlthoughOQ improves w/o RCT,RCT still allows for functional Va w/signif. improvement in QoL for complex pts. L-KPRO that does not unlock full OQ potential, though achieves functional improvement w/potentially lower risk may be a new paradigm in KPRO surgery. Further f/u is necessary to assess the long-term results.