Outcomes of bilateral sequential implantation of the Boston keratoprosthesis type 1.

OBJECTIVE: To evaluate the risks and benefits of sequential bilateral Boston type 1 keratoprosthesis (KPro) implantation for bilateral corneal blindness. DESIGN: Comparative retrospective study. PARTICIPANTS: Patients who underwent a sequential bilateral KPro surgery. METHODS: All 11 patients who underwent sequential bilateral KPro surgery at the Centre Hospitalier de l'Université de Montréal between October 2008 and October 2011 were recruited. Data from the 22 patient eyes in our study were separated in 2 groups based on the first (group 1) or second eye (group 2) implanted with the Kpro. Both groups were then compared for the best corrected visual acuity (BCVA) and complications. Bilateral BCVA following both surgeries and the overall number of complications that affected each patient after both interventions were also analyzed. RESULTS: At 24 months, BCVA was 20/150 in group 1 and 20/200 in group 2 (p = 0.67). Throughout the study, there was no significant difference in BCVA between the 2 groups (p > 0.05), and bilateral BCVA was similar. The complication rate was comparable in the 2 groups. Patients had a mean of 2.45 complications following the first surgery and a mean of 5.27 in both eyes combined after the second intervention (p = 0.03). CONCLUSIONS: Because visual gain observed following the second surgery was the same as that with the first and multiple surgeries increased the number of complications for each patient, we recommend saving bilateral KPro implantation for cases in which the first eye with KPro develops a disease limiting its visual potential.

Is there a role for optokinetic nystagmus testing in contemporary orthoptic practice? Old tricks and new perspectives.

Optokinetic nystagmus is a physiological oscillation of the eyes that requires intact development of motion perception, pursuit function, and saccadic function to be smoothly executed. Neuro-ophthalmological disorders often produce distinct perturbations in optokinetic responses that can be used to unmask the clinical diagnosis. With the advent of modern neuroimaging, optokinetic testing has slowly become a lost art in clinical examination. The purpose of this paper is to review the conditions wherein optokinetic testing provides a critical neurodiagnostic role, and to revitalize interest in this simple and valuable clinical tool.

Congenital ocular motor apraxia with wheel-rolling ocular torsion-a neurodiagnostic phenotype of Joubert syndrome.

Joubert syndrome is a multisystem disorder that is associated with a constellation of cyclic ocular motor disturbances. We describe 2 children with congenital ocular motor apraxia who displayed wheel-rolling torsional eye movements and tonic alternating cyclodeviations of the eyes on retinal examination as a neurodiagnostic phenotype of Joubert syndrome.