ESCRS - PP08.09 - Feasibility And Outcomes Of Endoscopy-Assisted Total Pars Plana Vitrectomy At Time Of Boston Keratoprosthesis Type 1

Feasibility And Outcomes Of Endoscopy-Assisted Total Pars Plana Vitrectomy At Time Of Boston Keratoprosthesis Type 1

Published 2022 - 40th Congress of the ESCRS

Reference: PP08.09 | Type: Case report | DOI: 10.82333/d3d4-w204

Authors: Dominique Geoffrion* 1 , Guillaume Mullie 2 , Nicolas Arej 3 , C. Maya Tong 2 , Marc-André Rhéaume 4 , Mona Harissi-Dagher 2

1Department of Ophthalmology,Centre hospitalier de l'Université de Montréal (CHUM),Montreal,Canada;Faculty of Medicine and Health Sciences,McGill University,Montreal,Canada, 2Department of Ophthalmology,Centre hospitalier de l'Université de Montréal (CHUM),Montreal,Canada, 3Department of Ophthalmology,Centre hospitalier de l'Université de Montréal (CHUM),Montreal,Canada;Rothschild Foundation Hospital,Paris,France, 4Department of Ophthalmology,Centre hospitalier de l'Université de Montréal (CHUM) ,Montreal,Canada

Posterior segment complications after Boston keratoprosthesis type 1 (Boston KPro) lead to severe visual loss but can be decreased with total pars plana vitrectomy (PPV) performed at the time of Boston KPro. However, anterior hyaloid peeling is challenging without endoscopy. The purpose was to report the first-ever case of endoscopy-assisted anterior hyaloid peeling at the time of Boston KPro implantation.

This was the first surgical case performed as part of a prospective, interventional study at the Centre hospitalier de l'Université de Montréal (CHUM). Perioperative reports were reviewed, including history, intraoperative results, best-corrected visual acuity (BCVA), intraocular pressure (IOP) by digital palpation, optical coherence tomography (OCT), and B-scan ultrasonography, over a 5-month period.

A 60-year-old male, with a history of two previously failed penetrating keratoplasties after ocular trauma with plugged iris in his left eye, was deemed eligible to benefit from Boston KPro and PPV. Preoperative evaluation was limited through the opaque-diseased cornea: BCVA = light perception (LP), no retinal detachment on B-scan, and IOP=26mmHg on 3 glaucoma drops. On surgery day, an unstable intraocular lens was removed. A Boston KPro was implanted, and a 3-port 23-gauge PPV was achieved with visualization through the Boston KPro optic and wide-angle viewing system, without a temporary KPro. Anterior hyaloid peeling was accomplished with endoscopy. Endoscopic intraoperative assessment revealed severe cupping suggestive of already advanced glaucoma, with unremarkable posterior pole and peripheral retina. A soft contact lens was applied. One week later, BCVA was hand motion (HM) and IOP=28mmHg on maximal tolerated medical therapy (MTMT). Five months later, BCVA was LP, IOP=20 mmHg on MTMT, and the optic remained clear, with no retroprosthetic membrane. Preexisting advanced glaucoma was only diagnosed once a clear optic was in place, hence little improvement in BCVA.

This novel combined procedure can be achieved in Boston KPro candidates. Endoscopy offers a rare in-situ view of the Boston KPro device and retroiridal structures, as well as complete removal of the anterior hyaloid membrane. Removing such proinflammatory membranes may decrease the incidence of sight-threatening complications in KPro patients and improve visual outcomes.