Transmucosal Boston Keratoprosthesis Type II in a Case of Severe Bilateral Chemical Burn.

PURPOSE: The purpose of this report was to describe a new alternative surgical technique combining oral mucosa and the Boston Keratoprosthesis type II (BKPro II) in a patient with severe chemical burn. METHODS: We present a case of a 37-year-old man who suffered a severe bilateral chemical burn. Visual acuity was light perception and projection in both eyes. After many surgeries, including eyelid reconstruction, eyelashes electrolysis, and amniotic membrane transplants, he presented a corneal thinning in his right eye that was managed with an autologous oral mucosa graft. Considering the limited function of the eyelids, mild symblepharon, and dry ocular surface, we proposed the implantation of a BKPro II. The patient voiced his desire of avoiding complete tarsorrhaphy for better cosmesis. Osteo-odonto-keratoprosthesis or tibial bone keratoprothesis was also discarded at the patient's express wish. A year and a half later, the oral mucosa was transplanted, and once the ocular surface was stabilized, we lift the mucosa 270 degrees and performed the implantation of the BKPro II covering this device with the mucosa trephined avoiding the complete tarsorrhaphy and theraby modifying the standard procedure. RESULTS: After 34 months of follow-up, the patient did not develop any complications, his visual acuity is stable (0.3 decimal), and funduscopic examination showed a pale optic disk, vascular tortuosity, and an epiretinal membrane that remains stable up to this period. CONCLUSIONS: Transmucosal BKPro II may be considered as an alternative surgical technique for implant support in BKPro II carriers who want to improve their cosmesis avoiding, avoid complete tarsorrhaphy, and do not want to be exposed to dental or bone surgeries.

Candida Colonization on the Surface of Contact Lenses in Long-Term Wearers and Boston Type 1 Keratoprosthesis Patients Presenting as White Mulberry-Shaped Deposits.

PURPOSE: To report Candida colonies on the surface of the contact lens in long-term contact lens wearers and patients with Boston type 1 keratoprosthesis (KPro I). METHODS: A retrospective study was performed based on analyzing cultures from bandage contact lenses with small whitish mulberry-shaped deposits on their surface. RESULTS: Eight samples (from seven patients) were positive for Candida. Seven of the eight were positive for Candida parapsilosis. CONCLUSIONS: The whitish deposits on contact lenses are often Candida colonies that colonize the surface but do not cause an active infection in the eye. C. parapsilosis is well-known for colonizing prosthetic devices. We underline the importance of including Candida species in the differential diagnosis of lens deposits, especially in susceptible patients such as keratoprosthesis carriers.

Sterile corneal necrosis after bowman layer transplantation.

Purpose: To report sterile corneal necrosis as a severe and rare complication after Bowman Layer Transplantation (BTL). Methods: A 35-year-old woman with Down syndrome and advanced progressive keratoconus in her left eye was scheduled for a BLT. The patient rubbed her eyes and did not tolerate contact lenses. Following standard technique, a 8mm Bowman layer graft was placed into a intrastromal pocket with no intraoperative complications. Results: Postoperatively, the patient remained stable and topography showed notable central flattening but 17 days after the BTL was performed she developed a sterile corneal necrosis. Conclusions: Many studies have proven the efficacy of this technique as a potential treatment for stabilizing progressive and advanced keratoconus in selected cases. Few complications associated with BTL have been reported, including Bowman Layer tears or buttonholes when obtaining the tissue, very thick grafts or postoperative hydrops but no sterile necrosis described to the date. A combination of the hypotheses raised in this paper may explain this undesirable event.

Transscleral Cyclophotocoagulation for the Treatment of Uncontrolled Glaucoma in a Boston Keratoprosthesis Type II Patient.

Postoperative endoscopic cyclophotocoagulation (CPC) for the treatment of glaucoma in patients with Boston keratoprosthesis type II (BKPro II) was first described in 2017 by Poon et al. (Endoscopic cyclophotocoagulation for the treatment of glaucoma in Boston keratoprosthesis type ii patient. J Glaucoma. 2017 Apr;26(4):e146-9). As we do not have this device, we present a case of transscleral CPC (TSCPC), in a BKPro II patient who had graft versus host disease and developed uncontrolled glaucoma. We dissected plane by plane to expose the bare sclera and performed the procedure as traditionally described. We concluded that this is a safe, controlled, and effective option in this patient population where the glaucoma treatment options are very limited. To the best of our knowledge, this is the first case report to describe the surgical technique of TSCPC in a BKPro II patient.