PURPOSE: To describe the clinical and histopathologic features of intractable secondary glaucoma induced by AlphaCor keratoprosthesis. METHODS: An elderly woman with pseudoexfoliation glaucoma and pseudophakic bullous keratopathy in the right eye had graft failures after penetrating keratoplasty. Her best-corrected visual acuity at presentation was counting fingers in the right eye and 20/30 in the left eye. Examination showed severe corneal neovascularization. Chirila keratoprosthesis type II was implanted in 2 stages. Ten months later, the patient developed dense retrocorneal membrane, 360 degrees occlusion of angles, intractable glaucoma, no light perception, and nasal stromal melting associated with partial extrusion of the keratoprosthesis. RESULTS: Histopathology revealed invasion of the porous material of the keratoprosthesis by reactive fibroblasts and multinucleated foreign-body giant cells. In the area of dehiscence, we noted thinning and lysis of the collagen fibers, infiltration of lymphocytes, and plasma cells with a sheet of fibroinflammatory tissue extending into the anterior chamber. CONCLUSIONS: Corneal stromal melting and retrocorneal prosthetic membrane formation after AlphaCor keratoprosthesis implantation led to intractable glaucoma and extrusion of the implant.
PURPOSE: To describe the clinical and histopathologic features of intractable secondary glaucoma induced by AlphaCor keratoprosthesis. METHODS: An elderly woman with pseudoexfoliation glaucoma and pseudophakic bullous keratopathy in the right eye had graft failures after penetrating keratoplasty. Her best-corrected visual acuity at presentation was counting fingers in the right eye and 20/30 in the left eye. Examination showed severe corneal neovascularization. Chirila keratoprosthesis type II was implanted in 2 stages. Ten months later, the patient developed dense retrocorneal membrane, 360 degrees occlusion of angles, intractable glaucoma, no light perception, and nasal stromal melting associated with partial extrusion of the keratoprosthesis. RESULTS: Histopathology revealed invasion of the porous material of the keratoprosthesis by reactive fibroblasts and multinucleated foreign-body giant cells. In the area of dehiscence, we noted thinning and lysis of the collagen fibers, infiltration of lymphocytes, and plasma cells with a sheet of fibroinflammatory tissue extending into the anterior chamber. CONCLUSIONS: Corneal stromal melting and retrocorneal prosthetic membrane formation after AlphaCor keratoprosthesis implantation led to intractable glaucoma and extrusion of the implant.
Authors: Luo Luo Zheng; Vijay Vanchinathan; Roopa Dalal; Jaan Noolandi; Dale J Waters; Laura Hartmann; Jennifer R Cochran; Curtis W Frank; Charles Q Yu; Christopher N Ta Journal: J Biomed Mater Res A Date: 2015-03-27 Impact factor: 4.396