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. 2015 Jan-Mar;10(1):26-32.
doi: 10.4103/2008-322X.156092.

Ultra high resolution optical coherence tomography in Boston type I keratoprosthesis

Siamak Zarei-Ghanavati  1 , Carolina Betancurt  2 , Alma Michelle Mas  2 , Jianhua Wang  2 , Victor L Perez  2
Affiliations

Ultra high resolution optical coherence tomography in Boston type I keratoprosthesis

Siamak Zarei-Ghanavati et al. J Ophthalmic Vis Res. 2015 Jan-Mar.

Abstract

Purpose: To evaluate the anterior keratoprosthesis-cornea interface in eyes with Boston type I keratoprosthesis (Kpro).

Methods: In a prospective non-interventional study, patients with Boston type I Kpro underwent ultra-high resolution optical coherence tomography (UHR-OCT) evaluation. The images were used to measure and describe characteristics of the anterior keratoprosthesis-cornea interface, epithelial interaction at the keratoprosthesis edge and the keratoprosthesis-cornea interface gap.

Results: Ten patients including 4 male and 6 female subjects with different preoperative diagnoses, i.e. 8 multiple corneal graft failures and 2 immunological ocular surface diseases, were studied. Mean age was 62.1 ± 20.0 (range, 33.0-83.0) years and mean interval between surgery and UHR-OCT evaluation was 15.2 ± 11.09 months. In eight patients, 360° epithelial growth over the peripheral edge of the Kpro was documented. We detected keratoprosthesis-cornea interface gap in three patients. One subject had developed postoperative endophthalmitis 8 months after surgery and the other two cases were among the high risk group according to the preoperative diagnosis. In one patient with severe ocular hypotony, the Kpro edge was inserted into the anterior stroma and covered with epithelium.

Conclusion: UHR-OCT showed that corneal epithelium covers the Kpro edge and seals the potential space between the Kpro and cornea in 80% of cases. The presence of a gap in the interface and lack of epithelial sealing around the Kpro edge might be associated with endophthalmitis.

Keywords: Anterior Segment OCT; Boston Type I Keratoprosthesis; Ultra High-resolution OCT.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Case 1; (a), UHR-OCT image shows keratoprosthesis-cornea interface gap (*) and epithelial defect on the cornea 3 days after surgery; (b), Epithelial growth over the Kpro edge (red arrows) on postoperative day 30 in UHR-OCT image, note that the gap has disappeared.
Figure 2
Figure 2
Case 5; (a), Slit lamp photo; (b), UHR-OCT image shows epithelial growth over the Kpro edge (red arrows). Note the epithelial cyst over the Kpro edge on the right (#).
Figure 3
Figure 3
Case 6; (a), UHR-OCT horizontal scan shows keratoprosthesis-cornea interface gap (*) which opens to ocular surface area (white arrow); (b), UHR-OCT vertical scan of the same patient. Note epithelial growth underneath the Kpro edge and over the Kpro on the left and right sides of the image, respectively. The gap only is present on the left side of the image where the epithelial layer has not covered the Kpro edge. Red arrows show the epithelial layer borders; (c), UHR-OCT, in case 8, shows a gap between keratoprosthesis-cornea interface (*). There is no connection between the gap and the ocular surface area, as the epithelium layer covered the Kpro edge and the gap (red arrows).
Figure 4
Figure 4
Case 9; (a), Slitlamp photo (b), UHR-OCT image shows lack of epithelial sealing and coverage over the Kpro edge and an associated interface gap. This patient had endophthalmitis at the time of imaging. The red arrows show borders of the epithelium.
Figure 5
Figure 5
Case 10; (a) UHR-OCT image shows embedded Kpro in the cornea; (b) Kpro edge is completely covered by corneal epithelium (red arrows) and inserted into the anterior stroma.
See this image and copyright information in PMC

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