MAR 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 92 of 210

E W CORNEA 90 March 2014 a re at high risk of allograft failure, including those with a history of prior graft failures, extensively vascularized corneas, or significant limbal stem cell deficiency." The Boston KPro would gener- ally be avoided in those patients who are good candidates for corneal a llografts, those without good visual potential, and those patients with severe dryness, ocular surface kera- tinization, or poor eyelid function, they said. "A modified KPro, referred to as a type II device, can be used in patients with severe autoimmune diseases affecting the cornea, for example mucous membrane p emphigoid or Stevens-Johnson syndrome, but requires extra train- ing to implant." Dr. Aldave thinks the titanium back plate would be best for those patients who may have an increased risk for RPM formation, specifically "those with other intraocular proce- dures performed at the time of keratoprosthesis implantation and t hose with the presence of a retro- corneal membrane on a previously excised corneal button." Disadvantages of the titanium back plate Dr. Colby cited some cosmetic differ- ences that may occur with the tita- nium back plate KPro. It's fine for p atients with blue eyes or hazel eyes, she said, but it may look a bit unusual in people who have brown irises. "Frankly, [for] most of the peo- ple who need a keratoprosthesis, the last thing they are worried about is what the eye looks like," she said. "But the cosmetic appearance is not q uite as natural as with PMMA, which is clear." The new design is also more expensive because of the titanium material, but she believes the advan- t ages outweigh the inconvenience of the expense. "There are no known medical limitations for the titanium ver- sion," Drs. Todani and Chodosh said. If patients are bothered by the metallic appearance, "the cosmetic appearance can be improved by use of a painted contact lens," they said. A dditionally, the titanium back plate is currently only available in one diameter (8.5 mm). Continuing to use the PMMA version Since there is no definitive evidence to show that the titanium back plate reduces the risk of RPM formation, w hich is the most common compli- cation after keratoprosthesis implan- tation, Dr. Aldave said the PMMA back plates can continue to be used. Drs. Todani and Chodosh said that the PMMA back plate is still a good option and has a "long and s uccessful track record of use." They noted that it is well established in both safety and efficacy. EW Reference 1. Todani A, Ciolino JB, Ament JD, et al. Tita- nium back plate for a PMMA keratoprosthesis: clinical outcomes. Graefes Arch Clin Exp Ophthalmol 2011;249(10):1515-8. Editors' note: The physicians have no financial interests related to this article. Contact information Aldave: aldave@jsei.ucla.edu Chodosh: james_chodosh@meei.harvard.edu Colby: kathryn_colby@meei.harvard.edu Todani: todani@doctors.org.uk Innovation. Selection. Value. Durability WinFame USA Inc e-mail: sales@winfameusa.com www.winfameusa.com ASCRS - ASOA 2014 Boston Booth 1580 Super I-Care Discounted Value with The Service you expected ASCRS - ASOA Boston MA. Booth #482 Phone or Text: 001-626-228-6119 www.super-i-care.com We Provide quality service and the lowest in-show quote for titanium instruments and knives. Guarantee! Exhibition Contact Phone or Text 626-255-9866 Ultrasound Scanners Titanium Instruments Black Diamond Knives Sapphire Knives Thermal Eye Mask Boston continued from page 88 88-107 Cornea_EW March 2014-DL2_Layout 1 3/6/14 3:46 PM Page 90

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