M G Jähne1. 1. Augenklinik des HELIOS Klinikums Aue.
Abstract
BACKGROUND: A keratoprosthesis should be implanted only in such eyes, in which a risk-keratoplasty (HLA-typified) was unsuccessful. However, the keratoprosthesis is an ultima ratio procedure. PATIENTS AND METHODS: 25 years ago a modified keratoprosthesis according to Cardona was implanted in 2 patients in 4 eyes with very heavy alkali burns. Complications are described in a 25-years follow up in all of the 4 eyes. The loss of visual acuity was the first alarm sign for each complication. Reversible epicorneal complications are: epithelium over-running in front of the prosthesis, retraction of mucosa, lyophilized sclera including fistulation and dislocation or extrusion of the prosthesis. The opposite of the epithelium over-running was the development of a retro-prosthetic membrane as a sign for over-running inside. Severe (intraocular) complications were: macular oedema and choriodal detachment in bulbar hypotension, vitreal haemorrhage, retinal detachement and exacerbation of a secondary glaucoma. An endophthalmitis and later a phthisis bulbi were observed due to a permanent fistulation. RESULTS: Exactly after 25 years the visual acuity is in both patients: patient 1: 0.6 p and amaurosis; patient 2: 1.3 p and 0.8 p. The visual field is limited by the keratoprosthesis usually to 30 to 40 degrees, in our both eyes with secondary glaucoma the visual field was reduced to 10 and 25 degrees. CONCLUSIONS: Bad auspices bring many complications and many operations. The patients should be sent back to the surgeons very early. Besides, a psychological guidance is important for the patients.
BACKGROUND: A keratoprosthesis should be implanted only in such eyes, in which a risk-keratoplasty (HLA-typified) was unsuccessful. However, the keratoprosthesis is an ultima ratio procedure. PATIENTS AND METHODS: 25 years ago a modified keratoprosthesis according to Cardona was implanted in 2 patients in 4 eyes with very heavy alkali burns. Complications are described in a 25-years follow up in all of the 4 eyes. The loss of visual acuity was the first alarm sign for each complication. Reversible epicorneal complications are: epithelium over-running in front of the prosthesis, retraction of mucosa, lyophilized sclera including fistulation and dislocation or extrusion of the prosthesis. The opposite of the epithelium over-running was the development of a retro-prosthetic membrane as a sign for over-running inside. Severe (intraocular) complications were: macular oedema and choriodal detachment in bulbar hypotension, vitreal haemorrhage, retinal detachement and exacerbation of a secondary glaucoma. An endophthalmitis and later a phthisis bulbi were observed due to a permanent fistulation. RESULTS: Exactly after 25 years the visual acuity is in both patients: patient 1: 0.6 p and amaurosis; patient 2: 1.3 p and 0.8 p. The visual field is limited by the keratoprosthesis usually to 30 to 40 degrees, in our both eyes with secondary glaucoma the visual field was reduced to 10 and 25 degrees. CONCLUSIONS: Bad auspices bring many complications and many operations. The patients should be sent back to the surgeons very early. Besides, a psychological guidance is important for the patients.