JAN 22, 2024
Predescemetic Keratoprosthesis (PD KPro) for Silicone Oil-Filled Phthisic Eyes
AAO 2023 Video Program
Cornea/External Disease, Keratoprosthesis
Type 1 keratoprosthesis (KPro) is performed for end-stage corneal diseases where corneal grafts have high chances of failure. One such condition is severe hypotony due to chronic ciliary body atrophy or tractional retinal detachment. Here, high-density silicone oil injection can maintain globe integrity but can also lead to corneal decompensation. In these scenarios, KPro placement has been successful, although they do have challenges, like loss of silicone oil leading to intraoperative hypotony, secondary retinal detachment, sudden hypotony causing vision loss in advanced glaucoma (wipe-out phenomenon), expulsive hemorrhage and infection. Therefore, we developed a closed-globe technique of predescemetic keratoprosthesis placement, wherein the Descemet membrane is spared during KPro placement and can be removed postoperatively with Nd:YAG capsulotomy or membranectomy if needed. This is safer as it prevents complications associated with open-sky surgery. This video describes keratoprosthesis in a prephthisic eye, a novel two-step closed-chamber technique, its outcomes and its comparison with conventional techniques.