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Lamellar corneal lenticule graft to treat keratolysis after AlphaCor keratoprosthesis implantation

Abstract

Purpose

Clinical assessment of AlphaCor keratoprosthesis and evaluation of surgical method to treat keratolysis in case of stromal necrosis occurrence.

Methods

This is a noncomparative, retrospective, interventional case series. The medical records of 12 eyes of 12 patients who underwent consecutive AlphaCor keratoprosthesis implantations were reviewed. Patients with severe bilateral corneal pathology unsuitable for a conventional corneal graft, a best-corrected visual acuity (BCVA) from light perception (LP) to 20/200, with no active ocular surface inflammation, controlled intraocular pressure prior to the surgery, and an unstimulated Schirmer test of >2.5 mm at 5 minutes were included. Postoperative medications included topical dexamethasone, ciprofloxacin, and 2% cyclosporine A. Main outcome measures included BCVA and complications occurrence.

Results

After a mean follow-up of 25 ± 12.3 months (range 2-38 months), 8 (66.7%) AlphaCor devices were retained. Postoperative BCVA ranged from LP to 20/63 (mean gain of 2.5 ± 3.1 lines). Seven cases of stromal melt (58.3%) occurred. Three were reversed to penetrating keratoplasty and 3 had a donor corneal layer fixated over the AlphaCor with satisfactory results (mean follow-up 23 ± 1.6 months). There were no instances of endophthalmitis, retinal detachment, or glaucoma exacerbation.

Conclusions

AlphaCor showed a low incidence of the classic keratoprosthesis complications but a high occurrence of recipient cornea necrosis. Corneal melts were successfully managed in 3 cases by lamellar corneal lenticule graft, thereby increasing the retention of AlphaCor and maintaining BCVA.

Eur J Ophthalmol 2015; 25(1): 1 - 7

Article Type: ORIGINAL RESEARCH ARTICLE

Article Subject: Cornea

DOI:10.5301/ejo.5000497

Authors

Louis Hoffart, Gérard Carles, Frédéric Matonti

Article History

Disclosures

Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.

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Authors

Affiliations

  • Ophthalmology Department, Aix-Marseille University - APHM, Hôpital de la Timone, Marseille - France
  • Pharmacy Department, APHM, Hôpital de la Timone, Marseille - France
  • Ophthalmology Department, Aix-Marseille University - APHM, Hôpital Nord, Marseille - France

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