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24. Kongress der DGII 2010
Abstracts DGII 2010
I.
Wissenschaftliche
Sitzung:
Hornhaut/Refraktive Chirurgie
V6
Boston Keratoprosthesis in Elimination of Corneal Blindness
JaÐinskas V
Eye Clinic of Kaunas University of Medicine (Litauen)
Purpose: To evaluate effectiveness of Boston keratoprosthesis (KPro)
in eliminating corneal blindness. Methods: Careful anamnestic data
collection with subsequent ophthalmological examination (VA, colour
perseption, slitlamp, A and B scan, IOP) of five patients suffering
from corneal blindness was performed. Two patients (men, aged 45
and 65 y.) without symblepharon (both suffering from alkaline burn)
were selected for Boston KPro implantation procedure. During surgery
Boston KPro was assembled with trepined 8,5 mm diameter
preserved donor cornea, implanted into trephined 8.0 mm diameter
recipient’s cornea, fixed with 16 single nailon 10/0 sutures and covered
with soft contact lens (CL). In both eyes lens was removed
during procedure (aphakia). First month after surgery two antibiotics,
covering both gram (+) and gram (–) bacterias ( Chloramphenicol 1 %
and Ciprofloxacin 0.3 % 4/day ) and steroids (Dexamethasone
4/day)
eye drops were prescribed; later Chloramphenicol 1 % and
Ciprofloxacin 0.3 % 2/day for permanent use. Conjunctival specimens
for bacteria and fungal culture was collected every months and
processed in microbiological laboratory. Change of bandage CL every 90
days to submit for bacterial and fungal culture. Results: Both patients
were observed for five months. First day after surgery slight
irritation in both eyes was detected, KPro was well centered, stable,
no percolation of aqueous humor was found. Two days after surgery
VA was 0.8 and 0.4. Two weeks later up to five month eyes were
calm without signs of inflammation. KPro and VA were stable, CL
covered corneas during all follow up period. In one case patient
loose his CL (twice) which was re-established in the same day. IOP
was in normal limits (palp.) in one case and .slightly elevated in
second. Eye fundus examination revealed no changes in first case
and glaucomatous cupping of the optic nerve had in second; for this
patient Cosopt eye drops 2/day were prescribed. Central zone of eye
fundus was easy to examine while periphery remained unexamined.
No external wound filtration was detected. Examination of specimen
from conjunctiva revealed no bacteria or fungi growth. Conclusion:
Boston KPro is effective method for elimination of avoidable corneal
blindness. Permanent usage of antibiotics and contact lens is required.
Careful patient’s selection and patient education sessions
are mandatory. Short term (five month) follow-up results are promising
and long term follow-up data is required.
Erschienen in:
Klin Monatsbl Augenheilkd 2010; 227: Suppl. 1, S1–S24
Georg Thieme Verlag KG Stuttgart · New York · ISSN 1431-634X
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