Use of Endoscopy in Keratoprostheses with Biological Haptics

Abstract

Introduction In severe ocular surface disease where penetrating keratoplasty cannot be successfully performed, implantation of a keratoprosthesis can achieve visual rehabilitation. Osteo-odonto-keratoprosthesis offers good tissue integration due to its biological haptics, resulting in a better survival rate and lower extrusion rate. Due to corneal opacity, which is often complete, assessing the potential visual acuity is challenging. Also, during implantation of a keratoprosthesis or during later intraocular revision surgery, there is a limited field of view of the peripheral retina or ciliary body region. This is due to the small size and central location of the prosthesis optics and the geometric conditions of the prosthetic haptics. These factors can complicate surgery.

Methods Endoscopic video assistance was used in 7 eyes of 6 different patients (6 male, 2 female, mean age 66 ± 9 years). In 3 eyes the indication was for preoperative estimation of potential visual acuity during a 23 G vitrectomy. In 2 eyes it was used during implantation surgery itself, and in 2 eyes it was used during revision surgery and vitrectomy. An endoscope with semirigid optics and an image guidance system with 3,000 pixels and 70°field of view from PolyDiagnost was used, with a 23 G trocar system.

Results Endoscopy was successfully applied in all eyes examined. In 1 of 3 eyes where endoscopy was performed to estimate the visual acuity potential, a keratoprosthesis was subsequently planned. In the other two eyes, the visual acuity potential was rated insufficient for future keratoprosthesis surgery. Detailed assessment of the retina and optic disc was limited to gross pathologies because of low image resolution. During implantation, it was possible to visualize correct positioning of the posterior haptic behind the host cornea. Retroprosthetic membranes could successfully be removed by endoscopy-assisted vitrectomy.

Conclusion Endoscopy assistance offers advantages in visualization both for determining the indication for KPro surgery, during implantation, and in the management of complications after implantation of a keratoprosthesis. Low resolution of the imaging system places limits on assessment capabilities. Although technical improvements and miniaturization may enhance its future capabilities, endoscopy in its current form is already a valuable addition in the context of keratoprosthesis surgery.

Key words

corneal blindness - keratoprosthesis - osteo-odonto-keratoprosthesis - OOKP - endoscopy

Publication History

Received: 24 June 2021

Accepted: 25 February 2022

Accepted Manuscript online:
23 March 2022

Article published online:
28 July 2022

• References/Literatur

• 1 Strampelli B. Osteo-odontokeratoprosthesis. Ann Di Ottalmologia E Clin Ocul 1963; 89: 1039-1044
• 2 Falcinelli G, Falsini B, Taloni M. et al. Modified Osteo-odonto-keratoprosthesis for Treatment of Corneal Blindness: Long-term Anatomical and Functional Outcomes in 181 Cases. Arch Ophthalmol 2005; 123: 1319-1329 DOI: 10.1001/archopht.123.10.1319.
• 3 Temprano J. Keratoprosthesis with tibial autograft. Refract Corneal Surg 1993; 9: 192-193
• 4 Hille K, Landau H, Ruprecht KW. Improvement of the Osteo-odonto-keratoprosthesis according to Strampelli: influence of diameter of PMMA cylinder on visual field. Graefes Arch Clin Exp Ophthalmol 1999; 237: 308-312 DOI: 10.1007/s004170050238.
• 5 Geerling G, Liu CSC, Dart JKG. et al. Sight and comfort: complex procedures in end-stage Stevens-Johnson syndrome. Eye (Lond) 2003; 17: 89-91 DOI: 10.1038/sj.eye.6700264.
• 6 Schmidt E, Benoit S, Kampik D. et al. Tibial bone keratoprosthesis: reversing blindness in mucous membrane pemphigoid. J Dtsch Dermatol Ges 2017; 15: 1024-1026 DOI: 10.1111/ddg.13317.
• 7 Frings A, Schrader S, Hille K. et al. Gesundheitsbezogene Lebensqualität nach Implantation einer Keratoprothese mit biologischer Haptik. Ophthalmologe 2018; 115: 34-39 DOI: 10.1007/s00347-017-0576-x.
• 8 Geerling G, Liu CSC, Collin JRO. et al. Costs and gains of complex procedures to rehabilitate end stage ocular surface disease. Br J Ophthalmol 2002; 86: 1220-1221 DOI: 10.1136/bjo.86.11.1220.
• 9 Geerling G, Hille K. Zum Stand der Keratoprothesen mit biologischer Haptik – Die Düsseldorf-Offenburger-Erfahrungen mit Osteo-Odonto- und Tibia-Keratoprothese. Klin Monbl Augenheilkd 2017; 234: 763-769 DOI: 10.1055/s-0043-111086.
• 10 Thorpe EH. Ocular endoscope: instrument for removal of intravitreous non magnetic foreign bodies. Trans Am Acad Ophthalmol Otolaryngol 1934; 39: 422-424
• 11 Hille K, Grabner G, Liu C. et al. Standards for Modified Osteoodontokeratoprosthesis (OOKP) Surgery According to Strampelli and Falcinelli. Cornea 2005; 24: 895-908 DOI: 10.1097/01.ico.0000157401.81408.62.
• 12 Juergens L, Michiels S, Borrelli M. et al. Das intraoperative OCT – eine Real-World-basierte Nutzerevaluation im operativen Alltag. Klin Monbl Augenheilkd 2021; 238: 693-699 DOI: 10.1055/a-1389-5815.
• 13 Farias CC, Ozturk HE, Albini TA. et al. Use of intraocular videoendoscopic examination in the preoperative evaluation of keratoprosthesis surgery to assess visual potential. Am J Ophthalmol 2014; 158: 80-86.e2 DOI: 10.1016/j.ajo.2014.02.043.
• 14 Pappuru RRR, Tyagi M, Paulose RM. et al. Role of Diagnostic Endoscopy in Posterior Segment Evaluation for Definitive Prognostication in Eyes With Corneal Opacification. Am J Ophthalmol 2017; 176: 9-14 DOI: 10.1016/j.ajo.2016.12.018.
• 15 Liu C, Okera S, Tandon R. et al. Visual rehabilitation in end-stage inflammatory ocular surface disease with the osteo-odonto-keratoprosthesis: results from the UK. Br J Ophthalmol 2008; 92: 1211-1217 DOI: 10.1136/bjo.2007.130567.
• 16 Emmerich K-H, Amin S, Meyer-Rüsenberg H-W. et al. Mikroendoskopische, minimalinvasive Techniken in der Tränenwegschirurgie. Ophthalmologe 2017; 114: 409-415 DOI: 10.1007/s00347-017-0481-3.
• 17 Cohen A, Wong SH, Patel S. et al. Endoscopic cyclophotocoagulation for the treatment of glaucoma. Surv Ophthalmol 2017; 62: 357-365 DOI: 10.1016/j.survophthal.2016.09.004.