Download Delayed Corneal Melt After Artificial Cornea

Clinical Associate Professor
Department of Ophthalmology
Loyola University at Chicago, U.S.A.
Visiting Professor
Department of Defense, Military Medical Academy
Belgrade, Serbia
The author has no Financial Interest in any aspect of this presentation.
Purpose:
• To report the clinical
outcomes of 5 patients
who experienced delayed
corneal melts after
artificial corneal
transplant surgery
Methods:
Retrospective chart review of patients
that underwent artificial cornea was
undertaken and cases of delayed
corneal melt were identified. These
patients had a high risk for corneal
graft failure and hence underwent
artificial cornea, namely, AlphaCor or
Boston Type I Keratoprosthesis
Results:
Five patients experienced a delayed
corneal melt following artificial
cornea surgery. The corneal melts
were circumferential and concentric
to the Boston keratoprosthesis. In
cases of AlphaCor, the corneal melts
occurred directly over the AlphaCor
with exposure of the optic and/or
the opaque skirt.
Results (Contd.):
All patients underwent anterior
lamellar keratoplasty to surgically
correct the areas of corneal melt
with or without amniotic membrane
transplant and fibrin tissue adhesive.
The AlphaCor melts were sterile
corneal melts, while the corneal
melts associated with the Boston KPro were secondary to an infectious
process.
DX: AlphaCor OD, Sterile Melt with Exposure of Skirt
Procedure: ALK + AMT + Fibrin Glue OD
Recurrence of Melt, Surgical Procedure Repeated OD
Stable with no recurrence of corneal melt OD
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84-year-old CF presented on February 19, 2008 with redness,
purulent discharge and discomfort OD x 1 wk. Patient had a
Boston keratoprosthesis (artificial cornea) combined with an
Ahmed valve OD on December 23, 2004. (Surgeon Dr. John)
Medications at the time of infection: Vancomycin (14 mg/cc)
QID, Pred Forte 1% QID and Zymar OD QID.
O/E ccVa of CF @ 1ft. IOP normal.
Ext. Exam = 4+ conj. injection & purulent discharge.
SLE: Dense corneal infiltrate extending from 10:30 to 2:00
o’clock position in a semilunar pattern . The inferior plates
of the BK-Pro were fully exposed and extruding above the
ocular surface.
Seidel test was negative.
Impression: Corneal ulcer and corneal melt, with exposed
BK-Pro plates and partial extrusion of the keratoprosthesis
Results (Contd.):
All globes were retained.
Recurrent melt required repeat
anterior lamellar keratoplasty in the
AlphaCor group.
One case had an exchange of Boston
K-Pro with no subsequent corneal
melt or recurrence of infection.
No recurrent corneal melt occurred in
the Boston K-Pro group.
Conclusions:
Delayed corneal melt after artificial
cornea can occur and require surgical
intervention.
AlphaCor-related corneal melts were
non-infectious while Boston K-Pro were
secondary to corneal infection.
Recurrent corneal melts occurred in the
AlphaCor group of artificial cornea
Clinical Associate Professor
Department of Ophthalmology
Loyola University at Chicago, U.S.A.
Visiting Professor
Department of Defense, Military Medical Academy
Belgrade, Serbia