ABSTRACT
PURPOSE: To report the intermediate- and long-term visual outcomes and complications with the Boston type 1 keratoprosthesis (KPro) for the management of aniridic keratopathy. METHODS: A retrospective chart review of 46 eyes of 34 patients (20 females and 14 males) with aniridic keratopathy who underwent Boston type 1 KPro surgery by a single surgeon from 2004 to 2012 with minimum 2-year follow-up was conducted. Preoperative, intraoperative, and postoperative parameters were collected and analyzed. The primary outcome was the change in best-corrected visual acuity. Secondary outcomes included the rate of retroprosthetic membrane formation, glaucoma progression, glaucoma tube revisions, and KPro retention. RESULTS: Mean age of the patients was 43.5 ± 19.8 years with a mean follow-up period of 4.5 ± 1.6 years (range 2-7.4 years). Thirty-four eyes (74%) had previously failed keratoplasty. Thirty-five eyes (76%) previously underwent ocular surface stem cell transplantation, specifically a keratolimbal allograft. Within the first 6 months postoperatively, 74% (34/46) of patients experienced a gain of ≥2 lines of vision. Overall, there was a gain of ≥2 lines of vision in 43.5% (20/46) of patients at last follow-up. The rate of retroprosthetic membrane formation was 61%, the rate of glaucoma onset/progression was 26%, the rate of tube revision was 31%, and the KPro retention rate was 87%. CONCLUSIONS: This study confirms that initial visual improvement in aniridic keratopathy cases occurs at a high rate with the Boston type 1 KPro but also found progressive loss of these initial visual improvements.
Subject(s)
Aniridia/complications , Artificial Organs , Cornea , Corneal Diseases/surgery , Postoperative Complications , Prosthesis Implantation , Visual Acuity/physiology , Adolescent , Adult , Aged , Child , Child, Preschool , Corneal Diseases/complications , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prostheses and Implants , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To report a single case of ocular surface squamous neoplasia (OSSN) that occurred in a living-related conjunctival limbal allograft (lr-CLAL). METHODS: Case report and literature review. RESULTS: A 70-year-old white man developed OSSN in a histocompatible identical lr-CLAL over 3 years after the surgical procedure. Incisional biopsy was performed, and topical interferon alpha-2b was initiated. Pathology results confirmed carcinoma in situ. After modest results with topical interferon alpha-2b, the patient was treated with excisional biopsy with mitomycin-C (0.04 mg/mL) and cryotherapy. Simultaneously, the lr-CLAL was replaced with a keratolimbal allograft of a deceased donor. The patient maintained 20/25 best-corrected visual acuity at last follow-up. CONCLUSIONS: We present an unusual case of primary OSSN in a recipient of an lr-CLAL that was clinically confined to the borders of the graft.
Subject(s)
Carcinoma in Situ/pathology , Conjunctiva/pathology , Conjunctival Neoplasms/pathology , Living Donors , Neoplasm Recurrence, Local/pathology , Stem Cell Transplantation , Aged , Allografts , Antibiotics, Antineoplastic/therapeutic use , Carcinoma in Situ/therapy , Combined Modality Therapy , Conjunctival Neoplasms/therapy , Cryotherapy , DNA, Neoplasm/genetics , Epithelial Cells/pathology , Humans , Limbus Corneae , Male , Mitomycin/therapeutic use , Ophthalmologic Surgical Procedures , Stem Cells/pathologyABSTRACT
PURPOSE: The aim of this study was to report the clinical features and management of patients with ocular surface damage during methamphetamine production accidents. METHODS: This is a retrospective noncomparative interventional case series of 5 patients with methamphetamine production-related ocular injuries referred to the Cincinnati Eye Institute between 1999 and 2014. RESULTS: Four of 5 cases were white young men with severe bilateral ocular injury and extremely poor vision. All except 1 eye (9 of 10) were diagnosed with total or near-total ocular surface failure. Limbal stem cell transplantation was performed in 8 of 10 eyes. Keratolimbal allograft was followed by penetrating keratoplasty in 7 of 10 eyes. Ocular surface stability was achieved in 7 of 10 eyes after keratolimabl allograft. Postoperative visual acuity was better than 20/200 in 4 of 10 of eyes. Keratolimbal graft rejection occurred in 3 of 10 eyes; the rate of rejection of penetrating keratoplasty was also 3 out of 10 eyes. CONCLUSIONS: Methamphetamine-related accidents can lead to severe bilateral ocular injuries. Although stem cell transplantation procedure success is guarded in most of these patients because of severe conjunctival inflammation and accompanying ocular comorbidities, as well as personality issues, compliant patients can achieve good visual function with ocular surface transplantation and subsequent keratoplasty.
