A Technique to Rescue Keratoprosthesis Melts.

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomaterials Science

Background:

• Boston keratoprosthesis (KPro) type 1 devices are crucial for vision restoration in severe corneal diseases.
• Disorders of the donor corneal carrier can compromise the function of an otherwise intact KPro.
• Existing methods for KPro failure may involve complete device explantation, leading to loss of the functional hardware.

Observation:

• A novel surgical technique was developed to completely replace the donor corneal carrier of a Boston keratoprosthesis (KPro) type 1.
• The technique involves excising the compromised donor cornea and inserting a thinned donor cornea after specific modifications to its central opening.
• The procedure was successfully performed in two eyes experiencing sterile corneal melts around the KPro stem.

Findings:

• The complete exchange of the donor corneal carrier was successful in both cases, preserving the KPro hardware.
• In one case, scarring of the KPro back plate mimicked Descemet membrane behavior during a subsequent deep anterior lamellar keratoplasty.
• The described technique allows for the selective replacement of the corneal carrier without disassembling the KPro device.

Implications:

• This salvage technique offers an alternative to complete KPro explantation when only the donor carrier is compromised.
• It allows for the preservation of the functional KPro hardware, potentially reducing costs and surgical complexity.
• This approach may improve outcomes for patients with KPro devices experiencing donor corneal carrier complications.