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 Professor

Department of Defense, Military Medical Academy

Belgrade, Serbia The author has no Financial Interest in any aspect of this presentation.

Purpose:• To report the clinical

outcomes of 5 patients who experienced delayed corneal melts after artificial corneal transplant surgery

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

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.

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.

DX: AlphaCor OD, Sterile Melt with Exposure of SkirtProcedure: ALK + AMT + Fibrin Glue ODRecurrence of Melt, Surgical Procedure Repeated ODStable with no recurrence of corneal melt OD

ALPHACOR S/P ALK FOR STERILE CORNEAL MELT

RECURRENCE OFCORNEAL MELT

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

BOSTON K-PRO INFECTIOUS CORNEAL MELT

BOSTON K-PRO INFECTIOUS CORNEAL MELT

S/P ALK + EXCHANGE OF BOSTON K-PRO

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.

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

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 Professor

Department of Defense, Military Medical Academy

Belgrade, Serbia