Abstract

SO.06.12

Keratoprostheses, résumé after 13 years of surgical experience

Hille K.
Ortenauklinikum, Offenburg

Objective: In Patients with severe ocular surface disorders like severe dry eye, symblepharon or diffuse vaskularisation the results of ocular reconstruction by corneal grafts or limbal stem cell transplantation are limited. In those patients a keratoprosthesis (Kpro) may be suitable for the recovery of vision. A KPro usually consists of an optic cylinder and a haptic made of biocompatible or biologic material like tibiabone (TKpro) or dentine (OOKP) to retain the optic in the surface of the body. Due to our experience we wanted to grade the value of different KPro.
Methods: In the last 13 years we implanted 46 KPro, 38 with biologic haptic (32 OOKP and 6 TKPro), and 7 KPro with biocompatible haptic (1 LEGAIS’s KPro, 7 PINTUCCI’s KPro). There was a follow-up examination about every half a year.
Results: The patients gained a visual acuity of ³0,9 in 33%, of ³0,5 in 63%, of ³0,2 in 70% a significant improvement of the visual acuity in 83% respectively. There was no significant difference between the different types of KPros concerning the visual acuity, but all patients with a poor improvement had a pre-existing end stage glaucoma or other visual impairing pre-existing ocular diseases. The medium follow-up of OOKP was 3.8 years (max. 10,2) and of TKPro 2,4 year (max. 3,9). In this time none of the OOKP and only 1 of the 6 TKpro was lost, but 5 of 8 of the KPro with biocompatible haptic with a medium follow up of 1,5 years (max. 4,9), 1 LEGAIS’s after 6 month and 4 of the PINTUCCI’s (p<0,01).
Conclusions: Most important in ranking of KPro’s different types are the percentage and duration of the anatomic success as visual acuity will be similar as long as a KPro is in site. The fixation of the KPro by a root of the patients own tooth (OOKP) will leed to the best results in the long-term follow up as our results as well as the literature demonstrates.

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