Elsevier

Ophthalmology

Volume 118, Issue 1, January 2011, Pages 41-46
Ophthalmology

Original article
Moscow Eye Microsurgery Complex in Russia Keratoprosthesis in Beijing

https://doi.org/10.1016/j.ophtha.2010.05.019Get rights and content

Purpose

To evaluate the efficacy and preliminary safety of the Moscow Eye Microsurgery Complex in Russia (MICOF) keratoprosthesis in eyes with complicated corneal opacities unsuitable for keratoplasty.

Design

Retrospective review of consecutive clinical case series.

Participants

We analyzed 85 eyes of 85 patients who previously underwent MICOF keratoprosthesis implantation at the Chinese PLA General Hospital between April 1, 2000, and August 31, 2009. The mean follow-up after MICOF keratoprosthesis implantation (measured after the second stage of the implantation) was 34.7 months (range, 3–107 months).

Methods

The MICOF keratoprosthesis surgery involves 2 procedures. In stage 1, a supporting titanium frame is inserted into the lamellar pocket; a polymethyl methacrylate (PMMA) optical cylinder is implanted 3 months later (stage 2). Data were collected from the preoperative, intraoperative, and postoperative courses. Statistical analysis was performed to identify factors influencing postoperative complications.

Main Outcome Measures

Visual acuity (VA), keratoprosthesis retention, and significant postoperative complications.

Results

The MICOF keratoprosthesis dramatically improved vision in most patients. The percentage of eyes with postoperative VA of 20/100 or better was 80.7% (67/83) at 6 months after stage 2, 82.4% (61/74) at 1 year, 72.7% (40/55) at 2 years, 78.8% (26/33) at 3 years, 78.9% (15/19) at 4 years, 100% (8/8) at 5 years, 80% (4/5) at 6 years, 100% (2/2) at 7 and 8 years, and 100% (1/1) at 9 years. The most common complication, retroprosthetic membrane formation, occurred in 39 of 85 eyes. The overall keratoprosthesis retention rate was 81.2% at an average follow-up of 34.7 months (range, 3–107 months). Ten eyes presented with elevated intraocular pressure after implantation; 3 of these had underlying glaucoma. All 3 eyes received cyclocryotherapy to control intraocular pressure. Sterile vitreitis occurred in 2 eyes, and retinal detachment occurred in 1 eye.

Conclusions

The MICOF keratoprosthesis is an effective alternative for patients with corneal blindness and a poor prognosis for penetrating keratoplasty.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

A retrospective review was performed of all MICOF keratoprosthesis procedures performed between April 1, 2000, and August 31, 2009 at the Chinese PLA General Hospital (Beijing, China). The indication for MICOF keratoprosthesis surgery was bilateral corneal blindness with severe corneal neovascularization caused by SJS, OCP, or any type of burn (alkali, acid, or thermal). All cases had a history of multiple failed corneal surgeries or ocular surface transplantation procedures and were judged

Surgical Procedure and Postoperative Management

The MICOF keratoprosthesis is composed of a central rigid PMMA optical cylinder (diameter, 2.5 mm) and a titanium frame. Cylinder length was 2.2 to 2.4 mm and selected according to the thickness of the cornea. The range of dioptric power was +55.00 to +62.00 diopters. The optical power was selected according to axial length as measured by A-scan ultrasonography.

Preoperative Characteristics

A total of 85 MICOF keratoprostheses were implanted in 85 eyes of 85 patients. Seventy-one patients were male and 14 patients were female, with a mean age of 44.9 years (range, 19–80 years). In all patients, preoperative best spectacle-corrected VA ranged from counting fingers to light perception; preoperative VA in the contralateral eye was light perception or not.

The most common preoperative corneal diagnosis was alkali burn (39 eyes, 45.9%), followed by thermal burn (20 eyes, 23.5%), acid

Preoperative Characteristics

Keratoprosthesis implantation in patients with corneal blindness is usually considered the last option for patients to regain sight in China. Thereafter, most eyes received prior corneal transplantations or were high risk for traditional PK. In our study, 41 of 85 eyes had a history of corneal transplantation; 18 eyes had received more than 1 corneal transplant. A previous study showed that eyes with prior transplantation failure from noncicatricial causes had the best prognosis (83% of those

References (16)

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Manuscript no. 2009-1321.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Yifei Huang and Jifeng Yu contributed equally to this work.

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