Use of intraocular video endoscopic examination in the preoperative evaluation of keratoprosthesis surgery to assess visual potential

Am J Ophthalmol. 2014 Jul;158(1):80-86.e2. doi: 10.1016/j.ajo.2014.02.043. Epub 2014 Feb 26.

Abstract

Purpose: To determine the clinical utility of intraocular videoendoscopy examination for the evaluation of the retina and optic nerve in patients being considered for a Boston type I keratoprosthesis (KPro).

Design: Interventional case series study.

Methods: Ten patients with a history of corneal blindness caused by failed penetrating keratoplasty (PK) and inability to accurately assess visual potential were included in this study. Ophthalmologic examination, B-scan ultrasonography, and pars plana videoendoscopy were carried out to assess the retina and optic nerve before KPro.

Results: Posterior segment examination was successfully used to evaluate the retina and optic nerve of all patients with opaque corneas. Out of 10 patients that underwent endoscopic examination, 3 (30%) were considered to be adequate candidates for KPro surgery and 7 (70%) were not. This was based on visualized retinal disease and/or optic nerve pathology. Of the 3 patients that underwent KPro surgery, all of them had a significant improvement of vision, including counting fingers to 20/100, hand motion to 20/5, and light perception to 20/80, as suggested by the endoscopy preoperative examination. No complications of the endoscopy procedure were observed.

Conclusions: This report demonstrates the successful use of intraocular videoendoscopy to rule out threats to a good visual outcome for patients being considered as candidates for KPro. Direct visualization of the posterior segment can be part of the preoperative algorithm in the decision process of performing a KPro surgery in patients when visual potential is questionable.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged, 80 and over
  • Artificial Organs*
  • Cornea*
  • Corneal Opacity / surgery
  • Decision Making
  • Endoscopy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Optic Disk / pathology
  • Optic Disk / physiopathology
  • Optic Nerve Diseases / diagnosis*
  • Optic Nerve Diseases / physiopathology
  • Patient Selection
  • Preoperative Period
  • Prosthesis Implantation
  • Retinal Diseases / diagnosis*
  • Retinal Diseases / physiopathology
  • Video Recording*
  • Visual Acuity / physiology*
  • Young Adult