Transcript singh-worst kpro - Eye Foundation Hospital

KERATOPROSTHESIS in EYE FOUNDATION
HOSPITAL
Fatai OLUYADI
KERATOPROSTHESIS
Keratoprosthesis is a surgical procedure
where a severely damaged or diseased
cornea is replaced with an artificial cornea.
 Keratoprotheses are made of clear plastic
with excellent tissue tolerance and optical
properties. They vary in design, size and in
the implantation techniques.
 The idea of artificial cornea was first
proposed in 1789 by French ophthalmologist
Guillaume Pellier de Quengsy.
 The first reported human KPro surgery with
a quartz crystal implant was performed by
Nussbaum in 1855
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SINGH WORST KPro
• BOSTON Kpro
• OSTEO-ODONTO Kpro
• ALPHA-COR KPro
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Keratoprosthesis -types
Multiple graft failure
Stevens-Johnson syndrome
Ocular cicatricial pemphigoid
Ocular burns (acid and alkali, thermal)
and other conditions with poor prognosis
with traditional PKP
 Procedure of last resort
- to give at least navigational vision
- not done if BVA both eyes > or= CF
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INDICATIONS &
CONTRAINDICATIONS
STEVEN JOHNSONS SYNDROMES
Vascularized cornea
Central KPro in a patient with Acid burns
8yrs post-op VA 6/36
Most common postoperative complications
in order of decreasing prevalence include:
 Retroprosthetic membrane
 Kpro Lens Extrusion
 Elevated intraocular pressure/glaucoma
 Infectious endophthalmitis
 Sterile vitritis
 Retina detachment (rare) and
 Vitreous hemorrhage (rare)
COMPLICATIONS
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Multicenter Boston KPro Study is the largest
published to date with 141 Boston type I
keratoprosthesis procedures from 17 surgical
sites by 39 different surgeons [.
At an average follow-up of 8.5 months,
retention rate of the device was 95%, 57%
had BCVA ≥ 20/200.
A large single surgeon series with 57
modern type I Boston KPro procedures from
UCLA medical center [16]. At an average
follow-up of 17 months, retention rate of the
device was 84%, 75% had BCVA ≥ 20/200.
Visual outcome
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Post-Op visual improvement: after Singh-Worst
KPro
If the media is clear and IOP under control, patient
can start seeing 6 hours after surgery. The visual
results may vary anything between 6/9 to simply light
perception. The average post-op VA is 6/36.
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However, if the media is reasonably clear, a patient is
quite happy being able to move around on his own if
the health of the optic nerve is not a limiting factor.
Prescription glasses also help in better visualization.
Most of Singh-Worst KPro patients tend to require
around +7.0D sphere.
Visual outcome
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The Boston
Keratoprosthesis
(Boston KPro) is a
collar button design
keratoprosthesis
(Kpro)
It is composed of a
front plate with a
stem, which houses
the optical portion of
the device, a back
plate and a titanium
locking c-ring
Boston keratoprosthesis
Osteo-odonto-keratoprosthesis
(OOKP) (also known as "tooth in eye"
procedure.
 It includes removal of a tooth from the
patient or a donor. After this, a lamina of
tissue cut from the tooth is drilled and the
hole is fitted with optics. The lamina is
grown in the patients' cheek for a period
of months and then is implanted upon the
eye
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Osteo-odonto kpro (ookp)
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Contains a peripheral skirt and a transparent central
region. These two parts are connected on a molecular
level by an interpenetrating polymer network, made
from poly-2-hydroxyethyl methacrylate (pHEMA).
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FDA-approved type of synthetic cornea measuring
7.0 mm in diameter and 0.5 mm in thickness.
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main advantages of synthetic corneas are that they
are biocompatible, and the network between the
parts and the device prevents complications that
could arise at their interface.
Alpha-cor keratoprosthesis
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Designed and developed in
collaboration with Dr. Jan
Worst in Netherlands and
Dr. Daljit Singh in India.
Champagne-Cork Design
for better stability.
one piece polycarbonate
device
anterior surface has a
diameter of 6.0mm
Shaft end diameter
4.5mm. Neck diameter 3.0
mm.
The flange has 8
equidistant holes near the
margin.
SINGH-WORST KPRO
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4 KPro surgeries done so far since April
2010
All with Singh-Worst Kpro Lenses obtained
from Dr Daljit Singh Amritsar North India
One lost to follow-up
One currently with VA LP
One with VA BCVA 6/36
Most recent case with BCVA 6/18
Keratoprosthesis at eye
foundation hospital
The Most Recent Case:
 33yrs old man
 Lost vision in both eyes
from acid injury 2years
ago
 Developed cicatricial
cornea lessions with
extensive Ankylo- and
Symblepharonin both
eyes with VA of LP
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RIGHT EYE
LEFT EYE
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Had Symblepharon
repair with superior
and inferior fornix
reformation and
Singh-Worst Kpro
Surgery in the Left
eye -July 2012
BCVA now 6/18
1 DAY POST-OP
8 DAY POST-OP