[Keratoprosthesis with Biological Haptic - The Düsseldorf-Offenburg-Experience with Osteo-Odonto- and Tibia-Keratoprosthesis]. / Zum Stand der Keratoprothesen mit biologischer Haptik ­ Die Düsseldorf-Offenburger-Erfahrungen mit Osteo-Odonto- und Tibia-Keratoprothese.

In severe ocular surface disease with limbal stem cell deficiency associated with severe dry eye, penetrating keratoplasty is likely to fail. In these cases, and provided the posterior segment is normal, keratoprosthesis surgery (KPro) can achieve visual rehabilitation. In KPros with an autologous biological haptic, a bone-tooth-complex (osteo-odonto-keratoprothesis, OOKPro) or a piece of tibial cortex (tibia-keratoprosthesis, TKPro) is used to carry a PMMA cylinder. This construct can successfully be implanted even in severely dry eyes and in those with autoimmune disease, in which other KPro designs frequently fail. Herein we review the published anatomic long-term results of OOKPro and TKPro on our own patients. With a mean follow-up of 7.5 years (max. 20.6) for OOKPro and 4.5 years (max. 13.3) for TKPro patients, the retention rate was 91 and 86%, respectively. We are unaware of any other technique for artificial replacement of the cornea with equally positive long-term results as KPros with a biological haptic.

Long-Term Outcomes of Keratoprosthesis With Biological Haptic: A Review of 25 Years of Single-Center Surgeries.

PURPOSE: To study the outcome of eyes that underwent surgery for keratoprosthesis with a biological haptic, osteo-odonto-keratoprosthesis (OOKP) or tibia keratoprosthesis, by a single surgeon over a time span of more than 25 years. METHODS: One hundred thirty eyes that had received a keratoprosthesis with a biological haptic between 1994 and 2022 by a single surgeon were included in this retrospective analysis. Main outcome parameters were postoperative best corrected visual acuity, postoperative refractive error, postoperative complications, anatomical and functional survival of the prosthesis as well as comparison of subgroups of the 2 different types (OOKP n = 78; tibia keratoprosthesis n = 52) of keratoprostheses, and subgroup analysis of different indications for surgery. Patients were examined every 6 months. RESULTS: The longest follow-up was 25.8 years. Reasons for implantation were graft-vs-host disease (6.9%), vascularized corneas and dry eye (22.9%), physical or chemical burns (29.8%), Stevens-Johnson syndrome (9.9%), and ocular cicatricial pemphigoid (30.5%). The functional success rate with postoperative visual acuity of better than 0.7 log MAR was achieved by 56.9%. The OOKP subgroup showed a better mean visual outcome. 14 keratoprostheses (10.7%) had to be explanted over the whole time span. In the time leading to explantation, refraction showed a statistically significant myopic shift when compared with the non-explanted prosthesis. Anatomical survival rates were better for the OOKP in the first 12 years after implantation. CONCLUSIONS: The study shows that keratoprosthesis with a biological haptic has favorable long-term outcomes. The retention rate stayed very high with excellent functional outcomes.

Suture-Probe Canaloplasty as an Alternative to Canaloplasty Using the iTrack Microcatheter.

PRéCIS:: Significant intraocular pressure (IOP) reduction was achieved using a novel suture-probe canaloplasty (SPCP) procedure in patients with glaucoma. The effect and low rate of surgical complications were comparable with those of iTrack canaloplasty. PURPOSE: Ab externo canaloplasty using the iTrack microcatheter has been established as a safe surgical procedure to treat open-angle glaucoma. This article, however, describes the results of a novel technique using a cost-efficient suture-probe as an alternative to iTrack canaloplasty and presents 12-month follow-up results. PATIENTS AND METHODS: SPCP was performed on 50 eyes of 50 patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and steroid-induced glaucoma. The mean±SD preoperative IOP was 21.9±7.0 mm Hg. A suture-probe was used to dilate Schlemm canal and to place a trabecular tensioning suture. Postoperative results were noted and statistically analyzed on the day of discharge from the clinic, and at 1.5, 3, 6, and 12 months of follow-up. RESULTS: In all eyes, the mean postoperative IOP 12 months after SPCP was 13.7±3.0 mm Hg. The number of medications decreased from 2.8±0.9 to 0.1±0.4, and visual acuity was 0.3±0.3 logMAR. Postoperative course and complications included: hyphema >1 mm (2%); microhyphema (4%); bleb leakage (2%); bleb suture (2%); laser goniopuncture (18%); laser suture lysis (4%); scleral flap lifting (4%); and iris incarceration following laser goniopuncture (4%). CONCLUSIONS: SPCP is an inexpensive procedure that can achieve significant IOP reduction in patients with glaucoma. The IOP-lowering effect and low rate of surgical complications were very similar to those of iTrack canaloplasty.

Keratoprosthesis surgery.

PURPOSE: To survey current knowledge of use of keratoprostheses for visual rehabilitation in the dry eye. METHODS: Sections deal with: (1) when a keratoprosthesis is indicated; (2) classification of keratoprostheses; (3) the osteo-odonto-keratoprosthesis (OOKP), its history, indications and contraindications, patient assessment, surgical technique, results and complications, and (4) the AlphaCor, its design, indications, results and complications. RESULTS: The choice of keratoprosthesis in the severely dry eye is straightforward, as only one device - the OOKP - will work. With careful assessment, adequate technique, regular follow-up, and early recognition and management of complications, most patients can look forward to many years of sight with an OOKP. In the appropriately managed marginally dry eye, an AlphaCor keratoprosthesis may be considered, although the device should be seen as an alternative to high-risk keratoplasty in multiple graft rejection and vascularised corneae. CONCLUSIONS: KPro surgery is a complex and growing field. Those interested are invited to join the KPro Study Group (www.kpro.org), to add their contribution to the ongoing research and device evaluation.

Standards for modified osteoodontokeratoprosthesis (OOKP) surgery according to Strampelli and Falcinelli: the Rome-Vienna Protocol.

PURPOSE: To establish a time-proven "gold standard" in modified osteoodontokeratoprosthesis (OOKP) surgery. METHODS: The OOKP is the procedure of choice for restoring sight in patients with corneal blindness caused by end-stage ocular surface disease not amenable to penetrating keratoplasty. Members of the OOKP Study Group met in Rome, Italy in 2001 and Vienna, Austria in 2002 to discuss indications and contraindications, patient selection, surgical technique, postoperative care, and recognition and management of complications of OOKP surgery according to Strampelli and modified by Falcinelli. RESULTS: Falcinelli's modification of Strampelli's technique of OOKP surgery remains the gold standard as far as visual and keratoprosthesis-retention results are concerned. The agreement on indications and contraindications, patient selection, surgical technique, postoperative care, and recognition and management of complications of this technique of OOKP surgery is summarized in the text of this manuscript. CONCLUSION: This standard technique of modified OOKP surgery, where adequately performed, is capable of providing excellent anatomic and functional results even in the long term. In patients with corneal blindness untreatable by other approaches, we strongly recommend this technique for visual rehabilitation. Students of OOKP surgery should become familiar with the protocol described in this paper before subjecting the technique to further modifications.

Malignant glaucoma due to drug-related angioedema.

PURPOSE: To report postsurgery angioedema resulting in malignant glaucoma. Interventional case report. METHODS: Three hours after uncomplicated cataract surgery on the right eye, a 61-year-old woman developed angioedema with swelling of the parapharyngeal tissue. Visual acuity deteriorated, and tonometry revealed an intraocular pressure of 60 mm Hg, with shallow anterior chambers, in both eyes. RESULTS: Ultrasound showed choroidal effusion on both eyes. Intraocular pressure could only be controlled surgically by procedure to deepen the anterior chamber. The angioedema regressed after withdrawal of candesartan, an angiotensin II antagonist that the patient had taken for 1 year. CONCLUSIONS: Angioedema without urticaria is well documented in patients receiving angiotensine-converting enzyme inhibitors or angiotensin II antagonists. Drug-related angioedema may lead to a choroidal effusion syndrome with malignant glaucoma. Surgical intervention may trigger angioedema. Most important in treatment is withdrawal from the implicated medication and control of intraocular pressure.

[Not Available]. / Der Zahn im Auge - Die erste in der Schweiz eingebrachte Osteo-Odonto-Keratoprothese.

We report on the first implanted Osteo-Odonto-Keratoprosthesis (OOKP) in Switzerland. The procedure is only performed in cases of severe bilateral corneal vision impairment without alternatives (e. g. allogenic corneal transplant). At this two-staged surgery a single-rooted tooth is removed with its belonging bone and an optic cylinder is centrally inserted. This tooth-bone-optic-cylinder-complex is implanted temporarily submuscular in the infraorbital area. Oral mucosa is removed and transplanted on to the eye. Three months later the complex is removed, the oral mucosa partially detached, the underlying cornea perforated, the lens, iris and anterior vitreous body removed and the tooth-optic-zylinder-complex fixated on the globe. After this procedure, our patient has a best corrected visual acuity of 0,7.

Prevalence of ocular manifestations in hereditary hemorrhagic telangiectasia.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a systemic disorder of the fibrovascular tissue. Few data have been published on the frequency of ophthalmologic manifestations. The aim of this study was to assess this frequency. METHODS: A prospective observational cross-sectional study was conducted in a multitude of clinical practices and in a tertiary referral center. The main outcome measure was the number of vascular malformations detected by an ophthalmologic inspection of the retina and the conjunctivae in both eyes in a random sample of patients with HHT. RESULTS: No retinal telangiectases were observed in any of the 75 patients (150 eyes) examined. Conjunctival telangiectases were detected in 28 of 74 patients (47 of 148 eyes). CONCLUSIONS: The prevalence of retinal telangiectases seems to be lower than 1/75 (< 1.3%). This data does not justify screening procedures to detect retinal telangiectases. Ophthalmologists should be aware of the symptoms of HHT and its systemic character.

Management and results of retinal detachment after silicone oil removal.

Of the 168 eyes undergoing silicone oil removal from 1993 to 2000, 34 developed retinal detachment after the removal of silicone oil. The management and the results of the 34 eyes were reviewed. Surgical procedures included pars plana vitrectomy, encircling band, cryocoagulation, endotamponade. Five of the 34 eyes had a second retinal detachment after these operations. One of these 5 eyes had a third retinal detachment. Final retinal reattachment was achieved in all eyes. Visual acuity decreased in 16 of the 34 eyes with retinal detachment, and 18 of the 34 eyes had a visual acuity of less than 0.02. These results show that surgery for retinal detachment after silicone oil removal yields a high rate of anatomic success, while the visual outcome is poor for a substantial number of patients.