Keratoprosthesis: A Vision of Hope for Eyes with Severe Corneal Damage

Treatment Familiarity:

Keratoprosthesis, also known as artificial corneal implant, is a complex surgical procedure reserved for individuals with severe corneal damage where traditional corneal transplantation (keratoplasty) is not a viable option. It involves implanting an artificial cornea made of synthetic materials to restore vision. This is a relatively uncommon procedure compared to traditional corneal transplants.

Procedure Breakdown:

The specific type of keratoprosthesis implant and surgical approach vary depending on the nature and severity of the corneal damage. Here’s a general overview:

1. Anesthesia: General anesthesia is typically used to keep the patient unconscious during surgery.
2. Recipient Corneal Preparation: The surgeon removes the damaged corneal tissue to create a space for the implant.
3. Implant Placement: The chosen keratoprosthesis is carefully positioned and secured to the surrounding eye structures.
4. Closure: The surgical site is meticulously sutured (stitched) closed.

Suitable Candidates:

Keratoprosthesis is considered a last-resort option for individuals with:

• Failed Corneal Transplants: Multiple rejections of donor corneas in traditional transplant surgeries.
• Severe Corneal Scarring: Extensive scarring that makes a traditional corneal transplant technically difficult or unlikely to succeed.
• Corneal Deformities: Significant abnormalities in the corneal shape that traditional transplants cannot address.

Who Might Not Be a Candidate?

Keratoprosthesis is not suitable for everyone. It’s generally not recommended for:

• Individuals with active eye infections: Infection increases surgical risk and can lead to implant failure.
• People with uncontrolled medical conditions: Severe health problems that could increase surgical risk may make someone a poor candidate.
• Patients with unrealistic expectations: Keratoprosthesis has a higher complication rate than traditional transplants, and vision restoration may not be complete.

Advantages of Keratoprosthesis:

• Potential for Vision Restoration: In successful cases, keratoprosthesis can offer sight restoration for individuals with severely damaged corneas who cannot benefit from traditional transplants.
• Advanced Technology: Newer keratoprosthesis designs offer improved biocompatibility and potentially better long-term outcomes.

Potential Complications:

• Rejection: The body’s immune system may react to the artificial implant, leading to rejection and implant failure.
• Infection: Although uncommon, infection is a serious complication requiring prompt antibiotic treatment and potentially removal of the implant.
• Glaucoma: Increased pressure within the eye can develop after surgery and require medication or additional surgery.
• Endophthalmitis: Infection within the inner eye can be a devastating complication.
• Vision Changes: Temporary blurred vision or fluctuations in vision are common after surgery. Vision restoration may not be complete.

Preoperative Care:

• Comprehensive eye exam to assess the severity of corneal damage and overall eye health.
• Detailed discussion of risks and benefits of keratoprosthesis with your ophthalmologist. This will involve a realistic discussion of potential outcomes and the higher complication rate compared to traditional transplants.
• Medical evaluation to ensure you can undergo surgery safely.
• Extensive testing to assess the risk of implant rejection.

Postoperative Care:

• Intensive eye drop regimen to prevent infection and inflammation.
• Wearing an eye patch or shield for a prolonged period to protect the surgical site and the implant.
• Anti-rejection medications may be used to suppress the immune system’s response to the implant.
• Regular follow-up appointments with your ophthalmologist are crucial to monitor healing, vision improvement, address any concerns, and detect potential complications early.