AlphaCor keratoprosthesis: a novel approach to minimize the risks of long-term postoperative complications

To describe clinical outcomes of patients who underwent implantation of the AlphaCor keratoprosthesis, without the second stage of the procedure, in which the central anterior layer of the corneal stromal pocket is excised to expose the keratoprosthesis optic to the exterior of the eye.

Outcomes of 6 consecutive cases of AlphaCor implantation without the second stage of the procedure were retrospectively reviewed. The cases were performed at 1 tertiary referral center between February 2005 and December 2006.

Each of the 6 treated eyes had experienced failure of 2-5 human donor grafts before AlphaCor implantation. With a mean follow-up of 22 months (range, 14-38 months), all devices remained in situ at time of review. All patients had decreased pain compared with what they experienced preoperatively, and preoperative bullous keratopathy resolved after AlphaCor implantation. Two patients developed retroprosthetic membranes. Five patients developed elevated intraocular pressure requiring additional medication or surgery in the postoperative course, but 4 of them had preexisting glaucoma. No patients developed breakdown of the ocular surface, increased ocular surface disease, stromal melting, aqueous leakage, infection, or extrusion.

Omitting stage 2 surgery of the AlphaCor implantation may decrease the incidence of complications and provide patients with a comfortable eye and improved cosmetic appearance in cases of bullous keratopathy from corneal graft failure and can be useful when there is little chance of a successful repeat graft and no urgency or possibility of restoring visual acuity better than approximately 20/200. Resolution of bullous keratopathy and reduction of pain was achieved despite the lack of functional endothelium.