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.
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