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[Boston Keratoprosthesis with temporal aponeurosis graft: A solution when there seems to be no more].
- Source :
-
Journal francais d'ophtalmologie [J Fr Ophtalmol] 2018 Nov; Vol. 41 (9), pp. 830-835. Date of Electronic Publication: 2018 Oct 19. - Publication Year :
- 2018
-
Abstract
- Purpose: To report cases of patients with severe bilateral corneal blindness and recurrent refractory perforation to keratoplasty and conventional treatment, for whom Boston keratoprosthesis (KP) was a satisfactory alternative when combined with a temporalis aponeurosis graft.<br />Description of Cases: The first patient had progressive Lyell syndrome with spontaneous corneal perforation. The second had a severe graft vs. host reaction with a persistent Seidel-positive descemetocele. Despite repeated penetrating keratoplasties, amniotic membrane (AM) transplantations, and buccal mucosal (BM) grafts, they both experienced recurrent corneal perforation. The only solution thus appeared to be Boston Type I KP surgery. One month postoperatively, the first patient had to receive a temporalis aponeurosis (TA) graft, due to thinning of the recipient graft. Six months postoperatively, his visual acuity (VA) was 1/10 without correction, and the corneal status had been stabilized. The second patient underwent KP and TA graft concurrently. Six months after surgery, VA was 2/10 uncorrected, and the local inflammation had been stabilized.<br />Observation: Boston type I keratoprostheses constitute an alternative in cases of severe bilateral corneal blindness with perforation refractory to conventional treatment and surgery, with satisfactory visual results.<br />Discussion: Patients with preoperative severe ocular surface disease are at greater risk of postoperative keratolysis. For our patients with a higher risk, TA graft prevented corneal melt. TA seems to be more effective than AM or BM in preventing corneal thinning or melt.<br />Conclusion: We would recommend performing a TA graft in combination with Boston KP surgery concurrently as first line treatment in eyes with severe ocular surface inflammation.<br /> (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)
- Subjects :
- Blindness etiology
Blindness surgery
Corneal Perforation etiology
Eye Neoplasms secondary
Eye Neoplasms surgery
Humans
Keratoplasty, Penetrating adverse effects
Leukemia, Myeloid, Acute pathology
Leukemia, Myeloid, Acute surgery
Male
Middle Aged
Postoperative Complications etiology
Prosthesis Implantation adverse effects
Stevens-Johnson Syndrome complications
Stevens-Johnson Syndrome surgery
Aponeurosis surgery
Aponeurosis transplantation
Corneal Perforation surgery
Keratoplasty, Penetrating methods
Prostheses and Implants
Prosthesis Implantation methods
Subjects
Details
- Language :
- French
- ISSN :
- 1773-0597
- Volume :
- 41
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Journal francais d'ophtalmologie
- Publication Type :
- Academic Journal
- Accession number :
- 30343989
- Full Text :
- https://doi.org/10.1016/j.jfo.2018.01.010