Forty-five years of keratoprosthesis study and application at the Filatov Institute: a retrospective analysis of 1060 cases

AIM: To present results of the keratoprosthesis method used at The Filatov Institute of Eye Diseases and Tissue Therapy. ·METHODS: A retrospective case series analysis was used to describe the development of new types of keratoprostheses and methods of implantation as well as different ways of leukoma strengthening. ·RESULTS: Keratoprosthesis was performed in 1 060 eyes of 1 040 patients with leukomas of different etiology: burns, 725 eyes (68.4% ); trauma, 120 eyes (11.3% ); keratitis and ocular pemphigoid, 108 eyes (10.2% ); and bullous keratopathy, 107 eyes (10.1% ). Visual acuity before keratoprosthesis consisted of light perception in 962 eyes (92% ), and 98 eyes (8% ) had minimal visual acuity (1/200-1/50). Both eyes were blind (visual acuity less than 1/200) in 955 patients (91.8% ). The period of blindness varied from 1 to 52 years. As a result of keratoprosthesis, visual acuity of ≥1/200 was restored in 1 023 of 1 060 eyes (96.5%). Visual acuity of 20/200-20/20 was achieved in 716 eyes (67.5%). At the last follow-up visit visual acuity of ≥1/200 was preserved in 806 eyes (76%), visual acuity of 20/200-20/20 was measured in 583 of 1 060 eyes (55%) and good keratoprosthesis fixation in the cornea was achieved in 986 of 1 060 eyes (93%). The minimal follow-up was 12 months (range, 12 months to 37 years, median 5 years). · CONCLUSION: Our techniques of keratoprosthesis effectively restore vision in patients with leukomas that cannot be treated by optical corneal grafting.

Implantation of Iakymenko keratoprosthesis in patients with severe ocular injury

AIM: To present the results of implantation of Iakymenko keratoprosthesis in five patients with vascularized corneal leukoma caused by severe ocular injury. METHODS: Iakymenko keratoprosthesis was implanted into 5 eyes of 5 patients: 4 patients were suffered from chemical burns and 1 patient from explosive injury. The preoperative visual acuity ranged from light perception to hand motion. The implantation surgery was composed of two-stage procedures. The follow-up period was from 9 months to 11 years. The outcome measures were visual acuity, retention, and complications of the keratoprosthesis. RESULTS: Vision improvements were achieved in most patients. All keratoprosthesis were retained within the follow-up period. Corneal melting occurred in one patient and fibrous closure in another patient, both of which were successfully treated. Retinal detachment occurred in one patient after surgery. CONCLUSION: Iakymenko keratoprosthesis seems to be a promising alternative for the patients with severe corneal injury, but further investigation is needed to evaluate the role of Iakymenko keratoprosthesis.

Intraocular tumours imaging with transpalpebral near-infrared LED transillumination:Pilot study

Purpose:To determine the possible use of near-infrared(NIR)light-emitting-diode(LED)radiation for imaging intraocular tumours by transpalpebral transillumination.Methods:This study was a pilot,open-label,prospective and non-interventional.Thirty patients(30 eyes;age 30–72 years)with uveal melanomas located in the iris,ciliary body,or choroid were under our observation.A biomicroscopy,ophthalmoscopy,transpalpebral NIR transillumination,and ultrasound examination were performed in all cases.Results:In all cases,NIR transillumination with transpalpebral approach enables visualization of the ciliary body and accurately estimates the projection of the pars plicata and ora serrata onto the sclera.In all patients,transpalpebral NIR transillumination made it possible to image the shadow of intraocular melanoma,estimate its dimensions and location concerning the ciliary body structures.Conclusions:We recommend the non-invasive transpalpebral NIR transillumination technique,together with traditional ultrasound imaging,to improve the accuracy of assessing the size and location of intraocular tumours.