|Year : 1984 | Volume
| Issue : 5 | Page : 405-407
Department of Ophthalmology, Medical College, Amritsar, India
Department of Ophthalmology, Medical College, Amritsar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh D. Keratoprosthesis. Indian J Ophthalmol 1984;32:405-7
The idea of artificial cornea was known to the great grand fathers of Ophthalmology 200 years back but the first keratoprosthesis was put in 1951 by Gyorffy which lasted for exact 13 days. Till 1983, about 26 reports have been published. The reported literature mentions 1165 human and 344 animal operations.
| Material and methods|| |
Singh's Keratoprosthesis [Figure - 1]
The present series of 25 cases has received a keratoprosthesis of following design : It consists of a cylinder 3.5 mm in diameter. There is a flange of th mm on the backside, the front side also carries a flange of 1 mm and is suitably curved to give power. The front flange has 8 holes of 0.25 mm in diameter.
A mid line full depth incision is made in the corneal area from 3-9°' clock. The edge of the incision are retracted and any remains of the iris and the lens are extracted. Anteriorvitrectomy is done. A roughly square opening is made in the centre of the cornea by cutting with a scissor on both sides of the incised cornea. 6-8 preplaced 50 micron stainless steel sutures are passed through the edges. The prosthesis is inserted so that the posterior flange is behind the level of the cornea. The steel sutures are tied and cut. At that stage the prosthesis is firmly held by the corneal tissue with the aid of steel sutures. Further fixation is achieved by 5-0 nylon passed between the holes of the front flange and all the four recti muscles. At the end of this fixation the prosthesis is firmly fixed to the globe. [Figure - 2]
| Observations|| |
There are summarised in [Table - 1][Table - 2][Table - 3][Table - 4][Table - 5]
20 patients were males and 5 were females,
18 patients were aphakes. The lenses of 7 phakic patients were removed. 7 patients had very thin false corneas and they also had incarcerated iris.
Immediate post-operative problems
Almost every patient had moderate congestion and oedema of the lids as well as ocular irritation and watering. This lasted for 7-10 days. There was persistent hypotony in two patients. Both these patients had hypotony before surgery.
Late post-operative problems:
The following table shows pre-operative and post-operative (the best and the latest corrected vision) visual results:
With passage of time, the visual results are bound to deteriorate further.
| Discussion|| |
Keratoprosthesis is still a very much neglected field of eye surgery. Inspite of its existence for more than 30 years the surgery has not shown spectacular results over long periods of time. A great deal of research needs to be done to help thousands of corneal blind patients who are beyond the help of keratoplasty. The initial results with keratoprosthesis are generally good, the vision tends to fall of with passage of time with all the varieties of complications that have been mentioned above. Since the surgery is performed on fairly damaged eyes due to other causes many of the complications are not unexpected. It is possible that with further research a prosthesis might evolve that will be suitable for border line cases of keratoplasty and still later might even replace keratoplasty.
| References|| |
Singh, D. 1982. Proceedings of All India Ophthalmolocial Conference.
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]