ABSTRACT
PURPOSE: To assess incidence, risk factors, and treatment of retroprosthetic membrane (RPM) formation in eyes following Boston keratoprosthesis (Kpro) implantation and their correlation with glaucoma drainage device placement (GDD). METHODS: A retrospective review was performed on eyes that underwent Kpro type I or II implantation between 2005 and 2020 at a tertiary academic center. Multiple variables were collected including preoperative characteristics, presence of RPM, management of RPM, and outcomes including corrected visual acuity (VA). A Fischer's exact test was used to evaluate the significance of risk factors of RPM formation and an odds ratio was calculated for each possible risk factor. A Mann-Whitney U test was used to evaluate comparisons between outcomes and qualitative analyses. RESULTS: Of the 87 eyes identified, 37 (43%) developed an RPM within an average of 1.5 years (range, 31 days-7.5 years) following Kpro implantation. Mean follow-up duration was 4.3 years. Eyes that developed RPM had significantly worse preoperative VA compared to those that did not (logMAR 2.55 vs. 2.28, p = 0.022). The mean number of prior penetrating keratoplasty procedures trended higher in eyes that developed RPM (2.46 vs. 2.18, p = 0.44) but was not significant. GDD placement after Kpro implantation was associated with an increased risk of RPM formation (RR = 1.69 p = 0.026). Of the 37 eyes that developed an RPM following Kpro, 17 (47%) were treated with Nd:YAG laser, and four of those 17 (21%) also underwent pars plana vitrectomy (PPV). Seven of 37 eyes (19%) underwent PPV without Nd:YAG. Comparisons between RPM occurrence and final VA were not significant. CONCLUSIONS: The incidence of RPM formation following Kpro implantation was 43%. Eyes that developed RPM had significantly worse preoperative VA. GDD placement after Kpro implantation increased the risk of developing RPM. Final VA and occurrence of RPM were not significantly different between the Nd:YAG and PPV treatment groups.
Subject(s)
Corneal Diseases , Glaucoma , Postoperative Complications , Visual Acuity , Humans , Retrospective Studies , Female , Male , Incidence , Risk Factors , Middle Aged , Glaucoma/surgery , Glaucoma/physiopathology , Glaucoma/epidemiology , Aged , Follow-Up Studies , Corneal Diseases/surgery , Corneal Diseases/diagnosis , Postoperative Complications/epidemiology , Artificial Organs , Intraocular Pressure/physiology , Prosthesis Implantation , Adult , Prostheses and Implants , Glaucoma Drainage Implants , Cornea/surgery , Aged, 80 and overABSTRACT
PURPOSE: To describe the presentation, microbiology, management, and prognosis of eyes with endophthalmitis after Boston keratoprosthesis implantation. METHODS: Retrospective case series with history, diagnostics, management, and outcomes data in endophthalmitis after keratoprosthesis implantation presenting to a tertiary center between 2009 and 2020. RESULTS: Of 137 keratoprosthesis-implanted eyes, 7 eyes of 7 patients (5%) developed endophthalmitis. On presentation, 6 (86%) reported decreased visual acuity, and only 1 (14%) reported pain. Peripheral corneal ulcers were present in 2 eyes (29%). Seidel testing was negative in all cases. Six eyes (86%) had retroprosthetic membranes. One (14%) underwent initial pars plana vitrectomy with mechanical vitreous biopsy, whereas 6 (86%) received a needle vitreous tap-half of which were dry. Organisms were isolated after vitreous tap in two eyes: Streptococcus intermedius and Mycobacterium abscessus. The mean visual acuity preendophthalmitis, at presentation, and at 6 months were 20/267, 20/5,944, and 20/734, respectively. The visual acuity improved 9.08 ± 11.78 Early Treatment Diabetic Retinopathy Study lines from presentation to 6 months. Six-month visual acuity was correlated with preendophthalmitis visual acuity (r = 0.92, P = 0.003) but not presenting visual acuity (P = 0.838). CONCLUSION: Visual acuity at 6 months is correlated with preendophthalmitis visual acuity, not presenting visual acuity. Endophthalmitis should be considered in the differential diagnosis of painless intraocular inflammation any time after keratoprosthesis implantation, even if Seidel negative.
Subject(s)
Artificial Organs , Cornea , Endophthalmitis/physiopathology , Eye Infections, Bacterial/physiopathology , Postoperative Complications , Visual Acuity/physiology , Aged , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Drug Combinations , Endophthalmitis/microbiology , Endophthalmitis/therapy , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Female , Humans , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium Infections, Nontuberculous/physiopathology , Mycobacterium Infections, Nontuberculous/therapy , Mycobacterium abscessus/isolation & purification , Prostheses and Implants , Prosthesis Implantation , Retrospective Studies , Streptococcal Infections/microbiology , Streptococcal Infections/physiopathology , Streptococcal Infections/therapy , Streptococcus intermedius/isolation & purification , Vitrectomy , Vitreous Body/microbiologyABSTRACT
PURPOSE: To assess the relationship between use of a hydrogel ocular sealant (Resure) to secure clear corneal incisions (CCIs) in cataract surgery and surgeon efficiency, patient symptomatology, and postoperative results. SETTING: Duke University Eye Center, Durham, North Carolina, USA. DESIGN: Retrospective case series. METHODS: A 1:1 matched cohort of hydrogel sealant exposure-discordant eyes of cataract surgery patients was retrospectively generated. Consecutive patients who had bilateral cataract surgery during the study period and in whom the hydrogel sealant was used to secure the CCI in only 1 of the 2 eyes were included in the study. The relationship between use of the hydrogel sealant and surgical time, 1-day postoperative foreign-body sensation, clinically noted corneal edema, and intraocular pressure (IOP) was evaluated. RESULTS: Ninety eyes of 45 patients were included in the study. One day postoperatively, no wound leak was found in any eye; the sealant was noted to be out of place in 2 (4.4%) of 45 cases. No statistically significant difference was found between sealant and non-sealant eyes in total surgical time (P = .16) or in IOP (P = .55), corneal edema (P = 1.00), or foreign-body sensation (P = .38) 1 day postoperatively. CONCLUSION: The hydrogel sealant was not observed to affect duration of surgery or 1-day postoperative IOP, corneal edema, or foreign-body sensation.
Subject(s)
Cataract Extraction , Hydrogels , Lens Implantation, Intraocular , Cornea , Humans , Intraocular Pressure , Lens, Crystalline , Retrospective Studies , Surgical Wound Dehiscence , Tissue Adhesives , Tonometry, OcularABSTRACT
PURPOSE: To report a rare case of atypical fibroxanthoma (AFX) of the bulbar conjunctiva, and to compare it with previously published cases of conjunctival AFX. METHODS: A 37-year-old woman developed a growth on the bulbar conjunctiva of her left eye that increased in size and redness over 4 months and was associated with blurry vision in the left eye, occasional diplopia, irritation of the eye, and increasing tearing. The mass was surgically excised. RESULTS: Slit-lamp examination disclosed a highly vascularized conjunctival lesion with intact lustrous epithelium and a raised nodular edge encroaching on the nasal corneal limbus of the left eye. Pathological examination and immunohistochemistry were diagnostic of AFX. CONCLUSIONS: AFX of the conjunctiva is rare, with this being only the fifth example of this neoplasm reported at this site. Complete surgical excision is the most appropriate treatment option.
