|Year : 2018 | Volume
| Issue : 5 | Page : 615-616
The journey of keratoprosthesis in India
Quresh B Maskati
Director, Cornea and Kpro Service, Maskati Eye Clinic, Mumbai, Maharashtra, India
|Date of Web Publication||20-Apr-2018|
Dr. Quresh B Maskati
Director, Cornea and Kpro Service, Maskati Eye Clinic, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maskati QB. The journey of keratoprosthesis in India. Indian J Ophthalmol 2018;66:615-6
Keratoprosthesis surgery has come a long way in the last 3–4 decades since Prof. Dohlman bemoaned that in 1992, only around 15 such surgeries took place in USA compared to more than 42,000 keratoplasties! In the latter part of the 20th century, many a researcher attempted to use different materials for the haptic, while the optic remained a transparent polymethylmethacrylate cylinder of varying dimensions and powers. Dr. F. Pintucci and Dr. Strampelli in Italy were pioneers in the development of biointegrated and biological haptics. They were followed by Dr. S. Pintucci and Dr. Falcinelli who refined the Pintucci keratoprosthesis  and the osteo-odonto-keratoprosthesis (OOKP), respectively. The Pintucci design has been further modified after Dr. S. Pintucci's demise and is now called the Chavan-Maskati-Pintucci or CMP keratoprosthesis, being made by Dr. Chavan in India and used by the author. The modified OOKP is practiced and taught at several centers by Dr. Falcinelli's students such as Mr. Liu in the UK and Dr. Iyer and others at the Sankara Netralaya, Chennai, India. There is now even an International Keratoprosthesis Society helmed since long by Prof. Parel of Miami which meets regularly where research scientists and keratoprosthesis surgeons interact and new ideas often emerge!
Prof. Dohlman's original design – the Dohlman-Doanne keratoprosthesis, popularly called the Boston keratoprosthesis, has also been modified mainly by his colleagues and students at the Mass Eye and Ear Infirmary (MEEI), with a resurgence of interest in the design worldwide in the last decade. This can be attributed to the drastic drop in infection rates following use of lifelong vancomycin drops and a large diameter scleral bandage lens changed at regular intervals. The MEEI also supplies the Boston keratoprosthesis Type 1 at a fifth of its USA price to corneal surgeons in lesser developed countries. They have gone a step further and allowed the Aravind Eye Care System, based in Madurai to manufacture the complete Type 1 keratoprosthesis under license from them, in South India, for use in Indian patients. This is available for a fifth of the discounted price that Indian eye surgeons pay to receive the original Type 1 keratoprosthesis from Boston! This and the multitude of trips made by Prof. Aldave of California to India to teach the technique to Indian corneal surgeons since 2008 have led to dozens of Indian surgeons performing the procedure routinely.
The review article on keratoprosthesis  is very timely and important for more reasons than one. It is fairly comprehensive in its coverage of indications and contraindications so that the general ophthalmic surgeon can know which cases are suitable for a keratoprosthesis and which should not be referred. Furthermore, the reader can glean sufficient information after perusing the article to determine which keratoprosthesis his patient is best suited for and sound out the patient about the pros and cons, the costs involved in terms of money, time, and follow-up visits so that the patient and his/her caregivers can decide whether or not to undergo the procedure. This saves considerable amount of chair time at the operating center and leads to less disappointment than if the patient made the trip to the operating center only to be told that he/she is not suitable for the procedure.
The review article may hopefully stimulate some readers to take up the challenging field of keratoprosthesis surgery as well as further research into newer designs by research institutes as the scope for improvement is tremendous. The article with its detailed description of the technique of surgery and the postoperative complications may also deter many a young surgeon from taking the plunge into keratoprosthesis surgery. This is not unwelcome. Keratoprosthesis surgery requires longtime commitment from the surgeon, meticulous preoperative assessment, surgical planning, and postoperative appraisal to treat complications in their nascent stage when possible. It also needs a different mental makeup from that required for routine cataract surgery and so is definitely not meant for every eye surgeon!
Even those ophthalmic surgeons not interested in ever doing keratoprosthesis surgery should read the article so that they may be able to answer routine preoperative and more importantly postoperative questions from their patients whom they have referred for having the surgery done at a particular center. Many of the larger centers are busy places, and doubts and questions the postoperative patient may have on reaching home a 1000 km away may not get instant answers from the operating surgeon, sometimes till it is too late. Furthermore, the referring eye surgeon will be able to recognize which complications deserve the patient to be rushed back to the operating surgeon and which can be safely tackled at his/her level, if required in consultation with the operating surgeon. Timely treatment of complications may make all the difference in long-term survival of the Kpro in the patientís only Seeing Eye.
I wish you happy reading!
| References|| |
Krachmmer JH, Mannis MJ, Holland EJ. Cornea. Vol. 3. St. Louis, Missouri, USA: Mosby; 1997. p. 1855.
Pintucci S, Pintucci F, Cecconi M, Caiazza S. New Dacron tissue colonisable keratoprosthesis: Clinical experience. Br J Ophthalmol 1995;79:825-9.
Maskati QB, Maskati BT. Asian experience with the pintucci keratoprosthesis. Indian J Ophthalmol 2006;54:89-94.
] [Full text]
Iyer G, Srinivasan B, Agarwal S, Talele D, Rishi E, Rishi P, et al
. Keratoprosthesis: Current global scenario and a broad Indian perspective. Indian J Ophthalmol 2018;66:620-9. [Full text]
| Authors|| |
Dr. Quresh Maskati passed his MS (Ophthalmology) and DOMS in 1983 with a gold medal. He was the first in India to start using a bio-integrated (Pintucci) keratoprosthesis in 1997, having performed approximately 90 such procedures to date. Dr. Maskati commenced use of Type 1 Boston Keratoprosthesis in 2009, and is the only ophthalmologist in solo private practice to offer both the keratoprosthesis. He was the first cornea expert invited to start online teaching by the All India Ophthalmological Society (AIOS) a decade ago, and the first corneal surgeon to be awarded an honorary FAICO degree by the AIOS. He played a major leadership role as the President of AIOS 2014-15. Dr. Maskati is academically active, is a keen reviewer for opthalmology journals, and is on the Editorial Board, Indian Journal of Ophthalmology.