Clinical Ophthalmology (Oct 2021)
Keyhole Anterior Lamellar Keratoplasty for Boston Keratoprosthesis Corneal Melt
Abstract
Thomas John,1,2,* Sean Tighe,3,4,* Hosam Sheha4,5,* 1Thomas John Vision Institute, Tinley Park, IL, USA; 2Department of Ophthalmology, Loyola University at Chicago, Maywood, IL, USA; 3Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL, USA; 4Department of Ophthalmology, Florida International University Herbert Wertheim College of Medicine & Glaucoma Research Organization, Miami, FL, USA; 5Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Hofstra Northwell School of Medicine, New York, NY, USA*These authors contributed equally to this workCorrespondence: Hosam ShehaManhattan Eye, Ear, and Throat Hospital, 210 East 64th Street, New York, NY, 10065, USATel +1 917-810-9555Email [email protected] TigheDepartment of Ophthalmology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USATel +1 813-690-0099Email [email protected]: Corneal melt remains a challenging complication of Boston keratoprosthesis (KPro) and may lead to disastrous consequences such as endophthalmitis, KPro extrusion, and permanent loss of vision. Several procedures have been suggested to repair established melts; however, KPro removal or exchange is often required due to high recurrence. We herein describe a novel surgical technique to repair corneal melt: a lamellar corneal graft is centrally trephined, and a radial cut is extended from the central opening to create a keyhole graft. The graft is draped around the KPro and tightly secured around the central stem. The radial cut is closed with sutures, and the graft is secured into the underlying tissue with fibrin glue and sutures. The graft remains stable with the KPro in place, while the patients maintain a 20/200 vision or better at two years. This technique is a useful alternative for securing KPro and preventing corneal melt recurrence.Keywords: corneal melt, keratoprosthesis, lamellar keratoplasty
