Flaum Eye Institute
Specialized Patient Care
Keratoprosthesis
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About Keratoprosthesis
For many patients, corneal transplants offer a way to restore vision following injury or other disease-related and congenital forms of blindness. The traditional method for this procedure is to suture natural human corneal tissue from a donor eye into a recipient eye. In some cases, however, traditional corneal transplants fail, or a patient may not be a good candidate for natural tissue transplant due to special circumstances. When natural cornea transplant is not an option, more and more physicians are recommending artificial corneas (KERATOPROSTHESIS) to restore precious vision.
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Dr. James Aquavella is an internationally recognized corneal surgeon who has been at the forefront of cornea research for decades. He recently evaluated a new artificial cornea device for implantation in cases of corneal blindness refractive to traditional keratoplasty and defined the indications for this keratoprosthesis in over 300 cases. He developed the techniques for use of this device in newborn infants and has treated babies from all over the world.
The Boston Keratoprosthesis is assembled utilizing a central optical cylinder with a surface plate which functions as a new entrance pupil and cornea refracting surface. It is fixed to a ring of donor cornea stroma surrounding the 3 mm optical cylinder and fastened by a fenestrated back plate and locking titanium washer. The device can then be implanted into a recipient eye using standard cornea transplant techniques. A hydrophilic bandage lens, worn over the entire surface, has been effective in eliminating many ocular surface problems common to cornea transplants.
This technique is effective in instances where traditional transplantation has failed or carries a poor prognosis. It also can be utilized as an alternative to a cornea transplant in that the visual rehabilitation occurs within days, the visual acuity obtained is not subject to astigmatism, and there is no potential for allograft rejection to occur.
Since infants and children have a very active immune system most corneal surgeons consider standard cornea transplant is doomed to failure. Amblyopia can best be avoided or treated by establishing a clear visual axis early in life thus our team operates in newborns at 4-6 weeks of age. Many of the conditions which produce congenital cornea opacity also result in abnormalities of the lens, intraocular pressure elevation, as well as vitre-oretinal disease. Dr. Aquavella’s infant team is composed of Dr's. Mathew Gearinger, Shakeel Sharef, and Mina Chung. They have the largest series of infant keratoprosthesis cases coming from all over the world.
Surgery
The surgical procedure is performed on an ambulatory basis with the patient returning home – or to a hotel if the patient is coming from a distance – the same day. Most surgeries are performed with the use of local anesthesia, with the exception of infants and young children where general anesthesia may be indicated. Patients can expect to be in the operating room area for at least three hours for this procedure, including one hour and 20 minutes for surgery as well as pre-operative and recovery time.
Follow-up Care
In all cases, patients return to the Eye Institute the day following surgery for reevaluation, necessary prescriptions, and post-operative care instructions. Additional follow-up exams are usually made after one week and every three months throughout the first year. For out-of-town patients, follow up visits after the one week interval can be made with a qualified ophthalmologist or corneal specialist who will be in frequent contact with Dr. Aquavella.
Risks and Discomforts
For patients with severe dryness or inflammation, keratoprosthesis can give excellent results but is more risky. In some instances a membrane can develop behind the keratoprosthesis and interfere with vision. This membrane can be opened using a tiny laser beam without requiring additional surgery. Rarely, tissue around the stem of the prosthetic device dissolves which can lead to the leakage of fluid from the eye leading to infection or even vision loss. In such instances the surgery may have to be repeated.
Costs
In most cases, the cost of Keratoprosthesis is covered by major U.S. medical insurance plans. You should contact them prior to scheduling surgery to check. For patients who do not have insurance coverage, including foreign patients, the Eye Institute has a package price of $35,000 U.S. for this procedure. This includes pre-operative visits, clinical testing, surgery, hospital fees and post-operative visits. Travel and out-of-pocket living expenses for out-of-town patients are not included in this fee and patients should plan accordingly.
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