Twenty-two eyes of 17 children with opaque corneas as a result of primary congenital disease and or previous failed keratoplasty.
Methods
A retrospective review of pediatric patients with a history of corneal opacification treated with keratoprosthesis surgery.
Main Outcome Measures
Intraocular pressure, inflammation, clarity of the visual axis, visual acuity, refraction, complications, and retention of the prosthesis.
Results
Twenty-two eyes of 17 patients 1.5 to 136 months of age underwent 23 keratoprosthesis procedures. The follow-up period was 220 patient months (range, 1–37 months; mean, 9.7 months). In both cases implanted with the AlphaCor (Argus Biomedical Pty. Ltd., Perth, Australia), the keratoprosthesis was not retained. In one instance, the prosthesis sustained traumatic dislocation and was replaced with a cadaver cornea. In the second instance, the intralamellar implant began to extrude and was replaced with a Boston keratoprosthesis. In all 21 Boston cases, the prosthesis was retained without dislocation or extrusion. The visual axis remained clear in 100% of cases, although retroprosthetic membranes were removed in 5 eyes. Reoperation was necessitated for management of concurrent glaucoma (n = 3) or retinopathy (n = 2). There were no instances of surface infection or endophthalmitis. In 7 instances where patient age was 4 years or more, visual acuity ranged from counting fingers to 20/30. In the remaining cases, all infants were able to follow light, fingers, and objects. Intraocular pressure was controlled in all cases.
Conclusions
Implantation of the Boston keratoprosthesis rapidly establishes and maintains a clear optical pathway and does not prejudice management of concurrent glaucoma or retinopathy. The device is retained without extrusion or rejection and is appropriate for the management of pediatric corneal opacity.
1University of Rochester Eye Institute, Rochester, New York.
2Department of Ophthalmology, University of Rochester, Rochester, New York.
3Wilmer Eye Institute of Johns Hopkins University, Baltimore, Maryland.
Correspondence to James V. Aquavella, MD, University of Rochester Eye Institute, 601 Elmwood Avenue, Box 659, Rochester, NY 14642.
Manuscript no. 2006-1040.
Supported in part by a Research to Prevent Blindness (New York, New York) Challenge Grant Award.
None of the authors have any direct or indirect financial interest in the devices or techniques described in the article, nor have they received gratuities or honoraria related to the presentation of the material herein described.
ABSTRACT