EyeWorld India September 2021 Issue

CORNEA 46 EWAP SEPTEMBER 2021 K eratoprosthesis (KPro) is not frequently discussed in the greater ophthalmic community. It is a rare procedure and there is only one device approved by the FDA for use in the U.S., the Boston KPro. Since its initial FDA approval in 1992, less than 15,000 Boston KPro procedures have taken place as of 2019. 1 Keratoprosthesis is an active area of research and development, however, and Sophie Deng, MD, PhD, said there have been recent innovations and updates to some devices in the keratoprosthesis field as a whole. Boston KPro update and insights The Boston KPro is the most commonly referenced keratoprosthesis in the U.S. In general, there have not been major changes to the Boston Type I KPro within the last 5 years, Dr. Deng said. Updates from the original design that occurred prior were the option for a titanium backplate that was slightly larger than the original PMMA backplate (the latter of which is still available, and Dr. Deng uses PMMA) and a snap-on backplate design (the previous version was screw on). Boston KPro allows for a quick visual recovery and excellent visual outcome shortly after surgery, Dr. Deng said. The key for long-term succe ss with by Liz Hillman EyeWorld Editorial Co-Director Contact information Bahar: iritbahar@gmail.com Deng: deng@jsei.ucla.edu Litvin: gilad@corneat.com Conversations about KPro KPro is in the postop regimen, she said. It is significantly more labor intensive than a corneal transplant, with patients on anti-inflammatories, antibiotics, antifungals, and sometimes glaucoma medications. She noted that it’s now standard of care for a patient with glaucoma to have a combined Boston KPro and tube shunt procedure. Weekly follow-up continues until the corneal surface is re- epithelialized, Dr. Deng said. After the patient is stable, the follow-up interval is adjusted to usually every 2–4 months. Dr. Deng said ophthalmologists performing follow-up care locally for KPro patients need to be familiar with all the possible complications associated with this procedure. “We have seen patients become NLP because the local ophthalmologists were not familiar with the risk of glaucoma. This is the leading cause of loss of vision in long-term follow- up. The other is infection. The infection is devastating and can blind people,” she said. “The ophthalmologist needs to recognize if there is any infiltrate in the donor tissue adjacent to the KPro and any epithelial defect or anterior chamber reaction that could indicate there is infection in the cornea. If they see those signs, the patients need to be treated with more aggressive antibiotic regimen. After keratoprosthesis, This article originally appeared in the July 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the A SCRS Ophthalmic Services Corp. Before and after the CorNeat KPro. Source: Gilad Litvin, MD