Fatai OLUYADIFatai OLUYADI

KERATOPROSTHESIS in EYE FOUNDATION HOSPITAL

KERATOPROSTHESISKERATOPROSTHESIS

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

Keratoprosthesis -typesKeratoprosthesis -types

• SINGH WORST KPro• BOSTON Kpro• OSTEO-ODONTO Kpro• ALPHA-COR KPro

INDICATIONS & INDICATIONS & CONTRAINDICATIONSCONTRAINDICATIONS

Multiple graft failure Stevens-Johnson syndrome Ocular cicatricial pemphigoid Ocular burns (acid and alkali, thermal) and other conditions with poor prognosis

with traditional PKPProcedure of last resort - to give at least navigational vision - not done if BVA both eyes > or= CF

STEVEN JOHNSONS SYNDROMES Vascularized cornea

Central KPro in a patient with Acid burns 8yrs post-op VA 6/36

COMPLICATIONSCOMPLICATIONS

Most common postoperative complications in order of decreasing prevalence include: Retroprosthetic membraneKpro Lens Extrusion Elevated intraocular pressure/glaucoma Infectious endophthalmitis Sterile vitritis Retina detachment (rare) and Vitreous hemorrhage (rare)

Visual outcomeVisual outcome

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 outcomeVisual outcome

Post-Op visual improvement: after Singh-Worst KProIf 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.

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.

Boston keratoprosthesisBoston keratoprosthesis

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

Osteo-odonto kpro (ookp)Osteo-odonto kpro (ookp)

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

Alpha-cor keratoprosthesisAlpha-cor keratoprosthesis

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).

FDA-approved type of synthetic cornea measuring 7.0 mm in diameter and 0.5 mm in thickness.

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.

SINGH-WORST KPROSINGH-WORST KPRO

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.

Keratoprosthesis at eye Keratoprosthesis at eye foundation hospitalfoundation hospital

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-upOne currently with VA LPOne with VA BCVA 6/36Most recent case with BCVA 6/18

LEFT EYE

The Most Recent Case:33yrs old manLost vision in both eyes

from acid injury 2years ago

Developed cicatricial cornea lessions with extensive Ankylo- and Symblepharonin both eyes with VA of LP

RIGHT EYE

Had Symblepharon repair with superior and inferior fornix reformation and Singh-Worst Kpro Surgery in the Left eye -July 2012

BCVA now 6/18

8 DAY POST-OP

1 DAY POST-OP