Boston artificial cornea

It also can be utilized as an alternative to a cornea transplant in that the visual rehabilitation occurs within days, the visual acuity obtained is not subject to astigmatism, and there is no potential for allograft rejection to occur.

Since infants and children have a very active immune system most corneal surgeons consider standard cornea transplant is doomed to failure. Amblyopia can best be avoided or treated by establishing a clear visual axis early in life thus our team operates in newborns at weeks of age. Many of the conditions which produce congenital cornea opacity also result in abnormalities of the lens, intraocular pressure elevation, as well as vitre-oretinal disease.

Aquavella's infant team is composed of Drs. They have the largest series of infant keratoprosthesis cases coming from all over the world. The surgical procedure is performed on an ambulatory basis with the patient returning home—or to a hotel if the patient is coming from a distance—the same day.

Most surgeries are performed with the use of local anesthesia, with the exception of infants and young children where general anesthesia may be indicated. Patients can expect to be in the operating room area for at least 3 hours for this procedure, including 1 hour and 20 minutes for surgery, as well as pre-operative and recovery time.

In all cases, patients return to the Eye Institute the day following surgery for reevaluation, necessary prescriptions, and post-operative care instructions. Shiple, M. Joshua Hardin, M. Corneal Transplant: Boston Dohlman Keratoprosthesis.

Corneal Surgery. Tired Of Glasses Or Contacts? Back to Top. There are several kinds: the most used is the Boston artificial cornea keratoprosthesis that Dr.

In the past, another artificial cornea or keratoprosthesis had great success: Prof. The Boston artificial cornea keratoprosthesis is the latest innovation and already the most used one worldwide. The increase in incidence of gram-positive IE cases in one study was the basis for the addition of topical vancomycin preserved with 0. Most surgeons recommend a topical fluoroquinolone and topical vancomycin in the initial postoperative period of all KPro eyes and then continuing dual agent coverage in autoimmune a group at higher risk for IE or monocular patients.

Some KPro surgeons recommend antibiotic cycling to prevent microbial resistance, although there are no published studies to support this. Regardless of regime employed, the incidence of this devastating complication is reduced with permanent topical antibiotic prophylaxis and patients should be educated on the important of compliance. Another postoperative management intervention is the indefinite placement of a bandage contact lens BCL.

The BCL has many other added benefits including improving patient comfort and protecting from possible exposed sutures. The benefit of the BCL is multifactorial and can include other therapeutic, refractive and cosmetic roles.

Ocular surface exposure can lead to KPro melt and failure and sometimes a tarshorraphy is necessary in addition to the BCL. The downside to BCL use is the increased risk of infection associated with contact lens use, especially when used on a chronic, extended wear basis. Life-long topical steroids such as prednisolone acetate is necessary in all KPro eyes to prevent inflammation and has been successfully utilized since inception of the device. It is believed inflammation is the most important factor for RPM formation [11].

Most cases are successfully treated with simple, single session YAG membranotomy. Typically surgical membranectomy is reserved for cases refractory to YAG laser treatment. The YAG laser should be used with caution at energy greater than 3. Despite best efforts at RPM monitoring and treatment with YAG laser, some patients will ultimately still progress and require more invasive surgical intervention.

With the significant reduction in IE with current antibiotic regimens, glaucoma is now the most significant threat to vision in KPro patients. Gradual closure of the anterior chamber angle is suspected as the etiology. This complication of KPro surgery is optimally managed in close consultation with an experienced glaucoma specialist and often requires filtration surgery with aqueous shunts and aggressive topical IOP-lowering agents.

Infectious endophthalmitis is a catastrophic complication often resulting in loss of vision. The most comprehensive series reports the overall incidence of IE as 2. For perspective, this is This is in contrast to sterile vitritis which also presents with a decrease in vision. On exam, flocculent vitritis is seen but typically without the pain, tenderness or conjunctival injection seen with IE.

If IE occurs, immediate evaluation and treatment is required. Intravitreal injection of vancomycin, amikacin and dexamethasone is recommended and pars plana vitrectomy is often necessary. Hospitalization should be considered in order to guarantee compliance with aggressive topical treatment, post-surgical care and possible IV antibiotics.

Four major clinical studies, summarized below, have reported outcomes with the type I Boston KPro. Our series at Weill Cornell Medical College, currently in press, is also summarized.

A pooled analysis of the above five clinical series yielded type I Boston KPro procedures performed in eyes of patients. Average follow-up weighted average in this cohort was Postoperative complications in this group included RPM in The WHO estimates that approximately 8 million people worldwide suffer from corneal blindness with the majority living in developing countries.

Pilot projects have been conducted in multiple countries including Sudan, Ethiopia, India and China with preliminary but promising results.

Nevertheless, the device is priced on an international sliding scale and is provided at a substantial discount to poorer nations. Reimbursement by Medicare, Medicaid, and other insurers for keratoprosthesis surgery has largely been successful.

However, certain conditions must often be met prior to surgery. For instance, Blue Cross will only reimburse for the surgery after two failed traditional corneal transplants, but this has been amended in certain states to include reimbursement for KPro as a primary surgery.

Thorough dictation which clearly states the indications for keratoprosthesis surgery is often necessary and can aid in collecting payor reimbursement.