Posters
Management of a Boston keratoprosthesis extrusion: a case report
Poster Details
First Author: R.Martin Pujol SPAIN
Co Author(s): S. Martin Nalda C. Garcia Arumi X. Garrell Salat L. Bisbe Lopez J. Puig Galy
Abstract Details
Purpose:
To discuss the medical and surgical treatment of a Boston keratoprosthesis extrusion.
Setting:
Vall d´Hebron Hospital. Barcelona. Spain.
Methods:
We present a case of an 80-year-old male with a Boston keratoprosthesis in the left eye. He was followed by the Cornea Section of our centre for the last 9 years. One of the examinations revealed an intense thinning of superior limbal area that developed into an extrusion. He underwent several topical treatments: therapeutic contact lenses, corticosteroid therapy and antibiotics, but finally a surgical treatment was required. A scleral patch graft was sutured above the extruded area. An amniotic membrane covering with fibrin glue (tissucol) and a superior conjunctival graft (Gundersen pedunculated flap) were also used to cover the sclera.
Results:
After surgery all the extruded area was covered. We placed a therapeutic contact lens with antibiotic and corticosteroid treatment. Two weeks after we observed a retraction of the conjunctival graft. We decided to have a second intervention and we used a free conjunctival autograft to cover the exposed area.
Conclusions:
Boston keratoprosthesis is a form of artificial corneal transplant reserved for the treatment of severe corneal disease in situations where corneal transplants have failed. Closed follow up of these patients is required as related complications can occur: infection, elevated IOP, device extrusion and retinal complications.
Corneal melting and device extrusion management includes a prompt surgery for reconstruction of the anterior segment. In most cases a replacement of the keratoprosthesis is required. Scleral patch grafts and conjunctival flap covering represent an improvement as a surgical treatment for these patients.
Financial Disclosure:
None
