Transcript RTVue CAM Anterior Segment OCT Imaging of Epithelial Lip

RTVue CAM Anterior Segment
OCT Imaging of Epithelial Lip
Overriding Front Plate of
Boston Type I Keratoprosthesis
Mary K. Daly, M.D. 1,2, Tulay Cakiner-Egilmez, Ph.D.,
N.P.2 , Robert W. Dunphy, O.D.2
The authors have no financial interest in the subject matter of this
poster. VA Boston Health Care System has received loan of
equipment from Optovue for research purposes.
1. VA Boston Health Care System
2. Boston University School of Medicine
Purpose: Endophthalmitis is a major concern following keratoprosthesis
(KPro) surgery and one of the most devestating sequelae. Integration of any
KPro with recipient tissue is crucial to avoiding extrusion and to ensure a
sealed, closed system. The Boston Type I KPro is comprised of a PMMA front
plate and stem, a backplate, and a locking ring. These components are
assembled with donor cadaver corneal tissue between the front and back
plate. The donor corneal skirt of the assembled KPro is then sutured into the
recipient corneal bed. Full time soft contact lens (BCL) wear is recommended
post-operatively to protect the front plate and improve hydration and
viability of the corneal tissue around the KPro. Visualization of corneal
epithelial growth around/over the edge of the front plate would be a
reassuring sign for surgeons that a barrier to microbial ingress exists.
Methods: Optovue RTVue CAM Anterior Segment OCT images of 4 eyes of 3
patients from the VA Boston Healthcare System with Boston Type I KPro were
retrospectively reviewed to assess relationship between the KPro PMMA
front
plate
and
donor
corneal
tissue.
Results: OCT Images of all 4 eyes demonstrated corneal epithelium
extending from the donor corneal tissue and overriding the edge of the KPro
front plate, a finding which was not always evident by slit-lamp examination.
One of these patients imaged in the immediate postoperative period
demonstrated such growth of epithelium at one week postop.
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Patient 1
Imaged without BCL
AGE (CURRENT): 84
OPERATED EYE: OS, 10/2007
PREOPERATIVE DIAGNOSIS:
herpes zoster keratitis left eye,
corneal scarring, corneal vascularization
KPRO TYPE: Pseudophakic Boston Type 1 Keratoprosthesis (PMMA Backp
CURRENT TOPICAL MEDICATIONS (OS):
1. Vancomycin 14mg/ml OS every other day
2. Vigamox QD
3. Prednisolone Acetate QD
4. Brimonidine BID
Front Plate
5. Travatan QHS
6. Refresh tears prn
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Vertical Section
Donor Cornea Skirt
Epithelium
Front Plate
Stem
Recipient / Donor Junction
Superior
Epithelium
Front Plate
Horizontal OCT sections
demonstrating
continuous epithelial
growth over peripheral
edges of front plate 2
years postop
Epithelium
Backplate
Front Plate
Patient 1
Inferior
Patient 2
OD
PMMA
Backplate
• AGE (CURRENT):88
• OPERATED EYE: OU
• SURGERY DATE: OD: 4/2004 OS: 2/2005
• KPRO TYPE: OD: PMMA OS: Titanium
• CURRENT TOPICAL MEDICATIONS:
• 1- Vigamox OU QHS
• 2- Vanco 14mg/ml OU QHS
• 3- Durezol OD BID
• 4- Pred Forte OS QHS OS
• 5 -Brimonidine OU TID TITANIUM
Backplate
• 6- Trusopt OU BID
Patient 2
OD PMMA
Front Plate
BCL
Epithelium
Image below modified to
enhance bandage contact
lens (BCL) and epithelium
signal
BCL
Epithelium
Stem
BCL
Epithelium
FRONT PLATE
Stem
Vertical section
OD Patient 2
Horizontal section edge of front plate
Epithelium
FRONT PLATE
OS
Patient 2
HORIZ OCT INTERSECT 3:30
Note gap
HORIZ OCT INTERSECT 2:30
OBLIQUE OCT INTERSECT 7:30
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AGE: (CURRENT) 88
Patient 3
PREOPERATIVE DIAGNOSIS OD: Pseudopahkic
bullous keratopathy, Fuchs, history of failed
corneal grafts x 2 secondary to immune graft
rejection
SURGERY DATE: OD 8/2007
• PREOPERATIVE DIAGNOSIS OS: Failed
DSEK/pseudophakic bullous keratopathy
• SURGERY DATE: OS 2/26/2010
KPRO TYPE OD: Boston Type I
keratoprosthesis (PMMA Backplate)
• KPRO TYPE OS: Boston Type I keratoprosthesis
(TITANIUM Backplate)
CURRENT TOPICAL MEDICATIONS OD:
1-Vanco 14mg/ml QD
2-Cosopt BID
3-Travatan QHS
4-Brimonidine TID
5-Vigamox QID
6-Prednisolone Acetate QID
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POST OP DAY 1 TOPICAL MEDICATIONS OS:
1-Vanco 14mg/ml QID
2-Cosopt BID
3-Travatan QHS
4-Brimonidine TID
5-Vigamox QID
6-Prednisolone Acetate QID
OS
Postop Day 1
Epithelium at edge and tracking under
front plate
BCL
Patient 3 OD
Front Plate
Donor Cornea Skirt
Stem
Recipient Cornea
Backplate
POST OP Day 1 OS Patient 3
FRONT PLATE
epithelium
POST OP Week 1 OS
Increased
suggesting
Patientsignal
3
epithelium
FRONT PLATE
GAP
Inferotemp
FRONT PLATE
epithelium
FRONT PLATE
Nasal
Increased signal suggesting
epithelium
epithelium
FRONT PLATE
Donor
Recipient
Inferior
Increased signal suggesting
epithelium
FRONT PLATE
Conclusions
Conclusions: OCT is useful in demonstrating
presence of an epithelial lip extending from the
donor corneal rim over the edge of the Boston
Type I KPro frontplate. The presence of such
epithelial growth is reassuring as it suggests a
tight seal and a barrier to infection.