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Keratoprosthesis: current techniques.

James V Aquavella1, Ying Qian, Gregory J McCormick

  • 1University of Rochester Eye Institute, Rochester, MN, USA. james_aquavella@urmc.rochester.edu

Cornea
|November 2, 2006
PubMed
Summary
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Keratoprosthesis (KPro) devices have evolved significantly. Modern Dohlman-Doane devices offer improved outcomes and reduced complications compared to older Cardona KPro models for keratoplasty in poor-prognosis eyes.

Area of Science:

  • Ophthalmology
  • Biomedical Engineering

Background:

  • Keratoprosthesis (KPro) surgery is a critical intervention for eyes with a poor prognosis for traditional penetrating keratoplasty.
  • Historical KPro devices, such as the Cardona device, presented significant challenges and complications.

Purpose of the Study:

  • To compare the techniques and outcomes of the Cardona keratoprosthesis (1975-1985) with the Dohlman-Doane type 1 keratoprosthesis (2003-2005).
  • To evaluate the evolution of KPro devices and their impact on visual rehabilitation in complex cases.

Main Methods:

  • Retrospective review of 31 Cardona KPro cases (1975-1981) and 25 Dohlman-Doane type 1 KPro cases (2003-2005).
  • Analysis focused on visual acuity, reoperations, and complications including endophthalmitis, retroprosthetic membranes, dislocations, and extrusions.

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Main Results:

  • Cardona KPro showed lower initial visual acuity (39% 20/40 or better) with significant degradation (16%), high revision rates (50%), and frequent complications (endophthalmitis 16%, membranes 58%, dislocations/extrusions 26%).
  • Dohlman-Doane type 1 KPro demonstrated no reoperations, endophthalmitis, dislocations, or extrusions to date, with 48% achieving 20/200 or better and 12% achieving 20/40 or better visual acuity. Retroprosthetic membranes occurred in 3 cases.

Conclusions:

  • Significant advancements in KPro device design and surgical techniques over 30 years have markedly reduced morbidity and improved visual rehabilitation prognosis.
  • Modern keratoprosthesis devices offer a safer and more effective solution for patients with severe corneal disease unresponsive to conventional treatments.