Keratoprostheses for corneal blindness: a review of contemporary devices

Venkata S Avadhanam,1,2 Helen E Smith,2 Christopher Liu1–3 1Sussex Eye Hospital, 2Brighton and Sussex Medical School, Brighton, 3Tongdean Eye Clinic, Hove, UK Abstract: According to the World Health Organization, globally 4.9 million are blind due to corneal pathology. Corneal transplantation is successful and curative of the blindness for a majority of these cases. However, it is less successful in a number of diseases that produce corneal neovascularization, dry ocular surface and recurrent inflammation, or infections. A keratoprosthesis or KPro is the only alternative to restore vision when corneal graft is a doomed failure. Although a number of KPros have been proposed, only two devices, Boston type-1 KPro and osteo-odonto-KPro, have came to the fore. The former is totally synthetic and the latter is semi-biological in constitution. These two KPros have different surgical techniques and indications. Keratoprosthetic surgery is complex and should only be undertaken in specialized centers, where expertise, multidisciplinary teams, and resources are available. In this article, we briefly discuss some of the prominent historical KPros and contemporary devices. Keywords: keratoprosthesis, OOKP, KPro, Boston KPro, cornea, ocular surface&nbsp

Suturing techniques and postoperative management in penetrating keratoplasty in the United Kingdom

Richard MH Lee,1 Fook Chang Lam,1 Tassos Georgiou,1 Bobby Paul,1 Kong Yong Then,1 Ioannis Mavrikakis,1 Venkata S Avadhanam,1 Christopher SC Liu1,21Sussex Eye Hospital, Brighton, United Kingdom; 2Tongdean Eye Clinic, Hove, United KingdomAims: To report on the suturing techniques and aspects of postoperative management in penetrating keratoplasty in the United Kingdom.Methods: A postal questionnaire was sent to 137 ophthalmic consultants identified from a Royal College of Ophthalmology database as having a special interest in anterior segment surgery. The questionnaire surveyed surgeon preferences for surgical and suturing technique for penetrating keratoplasty surgery, and the postoperative care of corneal grafts.Results: In all, 68% of questionnaires were completed and returned: 73% of respondents used a Flieringa ring or equivalent, 94% routinely used cardinal sutures, with 50.5% removing them at the end of the procedure. The most common suturing technique for routine penetrating keratoplasty was a single continuous suture (35%). In these cases, a 10/0 nylon suture was used by 89%. Sixty-six percent changed their technique in high-risk cases, 52% used a 3-1-1 knot, and 75% made a distinction between a reef and granny knot, with 76% using a reef. Thirty percent buried the knots within the donor material, and 29% within the host tissue. Twenty-five percent had no routine time for graft suture removal, but 41% removed them between 1 and 2 years post-surgery. After suture removal, 98% used steroids and 88% used topical antibiotics. Thirty-four percent stopped topical steroids before suture removal, with 38% stopping topical steroids more than 3 months prior to suture removal.Conclusion: This survey demonstrates that there is considerable variation in suturing techniques and postoperative care for penetrating keratoplasty. These significant variations in practice need to be considered when interpreting outcomes and research.Keywords: corneal graft, penetrating keratoplasty, anterior segment surgery, cornea, corneal surgery, corneal transplantatio