Eyeworld Daily News

22 | EYEWORLD DAILY NEWS | JULY 24, 2021 ASCRS ANNUAL MEETING DAILY NEWS T he second half of the ocular surface section at Cornea Day focused on more severe ocular surface disease and featured a variety of case presentations. Albert Cheung, MD, shared a case of unilateral LSCD from alka- li injury, and a key factor involved was deciding whether to use a SLET or CLAU procedure. The patient, he said, had sustained a work-related alkaline chemical injury to the left eye in- volving lime plaster more than 40 years ago. The patient had been told by multiple doctors that there was nothing to be done for his eye/vision. The patient was 20/20 in the right eye and had light per- ception in the left and had corneal neovascularization and corneal scarring that obscured the view to the anterior chamber. Dr. Cheung said he first opti- mized the ocular surface, and an oculoplastics colleague performed a mucous membrane graft. Dr. Cheung noted that he also wanted to minimize inflammation. The technique he ended up using was conjunctival limbal au- tograft plus keratolimbal allograft due to the conjunctival deficiency and inflammation. He also put the patient on mycophenolate mofetil (750 mg twice daily), and because of the patient's older age, he was able to use less immunosuppres- sion. He also used prednisone tapered over 2 months. For more rehabilitation, Dr. Cheung performed a manual dis- section DALK and noted that the patient will need cataract surgery. Michael Taravella, MD, shared a case of Boston KPro for aniridic keratopathy. He said that anirid- ia-associated keratopathy can be classified into several stages based on the appearance of the cornea: • Stage 1: Clear cornea • Stage 2: Some peripheral cloud- ing of cornea with minimal pannus • Stage 3: Minor opacification of cornea with pannus not affect- ing acuity • Stage 4: View of retina compro- mised, visual acuity reduced, corneal opacified, vessel in- growth to paracentral cornea • Stage 5: End stage, thick opaque pannus, fully vascular- ized cornea Dr. Taravella discussed the Boston KPro and its use for anirid- ia, speaking specifically about the KPro type 1. Pros of using this for aniridia include that it's a similar tech- nique to penetrating keratoplasty, there is no need for an IOL, it blocks light, and you can use sub- optimal tissue, Dr. Taravella said. Cons are the intense follow-up and potential complications (keratitis/endophthalmitis, sterile melts, etc.). While the Boston KPro sur- gical technique is similar to penetrating keratoplasty, Dr. Taravella added he likes to over- size the donor by 0.5 mm to avoid stretching the central opening when suturing. Centration of the optic is critical, he added. The Boston KPro type 1 has the option of an aphakic central optic, so you don't have to put an IOL in, and there is less hardware in the eye. The power is based on axial length only, Dr. Taravella said. He added that a need for cataract surgery is likely. The KPro backplate is also helpful for blocking light and can be colored for a more natural appearance. The majority of patients do obtain improvement greater than or equal to two lines, Dr. Taravella said, but as you follow patients for longer periods of time, the improvement drops off because of complications. Potential complications like infection, retroprosthetic mem- brane, sterile melts, and glaucoma can be an issue. Editors' note: Dr. Taravella has no relevant financial interests. Dr. Cheung has financial interests with LayerBio. Ocular surface case presentations Dr. Taravella shares a case presentation of Boston KPro for aniridic keratopathy. Source: ASCRS

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