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Delayed Corneal Melt After Artificial Cornea: AlphaCor and Boston Keratoprosthesis

Delayed Corneal Melt After Artificial Cornea: AlphaCor and Boston Keratoprosthesis. Thomas John, MD. Clinical Associate Professor Department of Ophthalmology Loyola University at Chicago, U.S.A. Visiting Professor Department of Defense, Military Medical Academy Belgrade, Serbia.

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Delayed Corneal Melt After Artificial Cornea: AlphaCor and Boston Keratoprosthesis

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  1. Delayed Corneal Melt After Artificial Cornea: AlphaCor and Boston Keratoprosthesis Thomas John, MD Clinical Associate ProfessorDepartment of OphthalmologyLoyola University at Chicago, U.S.A.Visiting ProfessorDepartment of Defense, Military Medical AcademyBelgrade, Serbia The author has no Financial Interest in any aspect of this presentation.

  2. Purpose: • To report the clinical outcomes of 5 patients who experienced delayed corneal melts after artificial corneal transplant surgery

  3. Methods: Retrospective chart review of patients that underwent artificial cornea was undertaken and cases of delayed corneal melt were identified. These patients had a high risk for corneal graft failure and hence underwent artificial cornea, namely, AlphaCor or Boston Type I Keratoprosthesis

  4. Results: Five patients experienced a delayed corneal melt following artificial cornea surgery. The corneal melts were circumferential and concentric to the Boston keratoprosthesis. In cases of AlphaCor, the corneal melts occurred directly over the AlphaCor with exposure of the optic and/or the opaque skirt.

  5. Results (Contd.): All patients underwent anterior lamellar keratoplasty to surgically correct the areas of corneal melt with or without amniotic membrane transplant and fibrin tissue adhesive. The AlphaCor melts were sterile corneal melts, while the corneal melts associated with the Boston K-Pro were secondary to an infectious process.

  6. DX: AlphaCor OD, Sterile Melt with Exposure of Skirt Procedure: ALK + AMT + Fibrin Glue OD Recurrence of Melt, Surgical Procedure Repeated OD Stable with no recurrence of corneal melt OD ALPHACOR S/P ALK FOR STERILE CORNEAL MELT RECURRENCE OFCORNEAL MELT

  7. Boston K-Pro – Infectious Keratitis • 84-year-old CF presented on February 19, 2008 with redness, purulent discharge and discomfort OD x 1 wk. Patient had a Boston keratoprosthesis (artificial cornea) combined with an Ahmed valve OD on December 23, 2004. (Surgeon Dr. John) • Medications at the time of infection: Vancomycin (14 mg/cc) QID, Pred Forte 1% QID and Zymar OD QID. • O/E ccVa of CF @ 1ft. IOP normal. • Ext. Exam = 4+ conj. injection & purulent discharge. • SLE: Dense corneal infiltrate extending from 10:30 to 2:00 o’clock position in a semilunar pattern . The inferior plates of the BK-Pro were fully exposed and extruding above the ocular surface. • Seidel test was negative. • Impression: Corneal ulcer and corneal melt, with exposed BK-Pro plates and partial extrusion of the keratoprosthesis

  8. BOSTON K-PRO INFECTIOUS CORNEAL MELT

  9. BOSTON K-PRO INFECTIOUS CORNEAL MELT S/P ALK + EXCHANGE OF BOSTON K-PRO

  10. Results (Contd.): All globes were retained. Recurrent melt required repeat anterior lamellar keratoplasty in the AlphaCor group. One case had an exchange of Boston K-Pro with no subsequent corneal melt or recurrence of infection. No recurrent corneal melt occurred in the Boston K-Pro group.

  11. Conclusions: Delayed corneal melt after artificial cornea can occur and require surgical intervention. AlphaCor-related corneal melts were non-infectious while Boston K-Pro were secondary to corneal infection. Recurrent corneal melts occurred in the AlphaCor group of artificial cornea

  12. Delayed Corneal Melt After Artificial Cornea: AlphaCor and Boston Keratoprosthesis Thomas John, MD Clinical Associate ProfessorDepartment of OphthalmologyLoyola University at Chicago, U.S.A.Visiting ProfessorDepartment of Defense, Military Medical AcademyBelgrade, Serbia

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