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The Aachen-Keratoprosthesis Type 3 - Case Report of the First Application
1Kompa S., 2Frentz W., 3Frentz M., 4Berndt E., 1Schrage N. F.,
1RWTH Aachen, Universitätsaugenklinik (Aachen)
2RWTH Aachen, Institut für Aerodynamik (Aachen)
3IZKF "Biomat." (Aachen)
4RWTH Aachen, Institut für Textiltechnik (Aachen)
Purpose: The intraoperative application of the Aachen-Keratoprosthesis (KPro) Type 1 during vitrectomies has been established. The design of the Aachen-KPro has been modified based on experiences with the temporary application of the single-piece Aachen-KPro Type 2 for three months. The Aachen-KPro Type 3 is composed of a new polyvinylidenfluoride (PVDF) haptic connected to the soft silicone-optic by vulcanization. Cell culture experiments showed a high ingrowth of L929 mouse-fibroblasts into the meshwork, providing a tight union between the KPro and the human tissue. The promising in vitro results led to the first in vivo application of the Type 3 KPro.
Methods: A patient suffering from bilateral eye-burn with a Dohlmann-KPro in his single eye presented with severe endophthalmitis. Visual acuity was no light perception. The Dohlmann-KPro was explanted. Using the Aachen KPro Type 1 as an intraoperative tool, a vitrectomy was performed. Retina could be identified. Therefore the Aachen-KPro Type 3 was implanted and the eye was filled with silicone-oil.
Results: Despite some intraoperative leakage through the meshwork, the postoperative IOP was stable. The Aachen-KPro provided good visualisation of the vitreous cavity and retina in the upper part of the prosthesis. In the lower part, the textile structure stuck to the posterior surface of the KPro. Two weeks after implantation, refixation of the conjunctiva was necessary due to slight dehiscence. After three weeks, a retroprosthetic membrane developed, which made funduscopy more difficult. The IOP, measured with a modified Schiotz tonometer, was 7 mmHg.
Conclusions: In the past, most KPro implanted eyes that developed endophthalmitis had to be enucleated. Although keratoplasty is not successful in these eyes due to immense scarring, the Aachen-KPro Type 3 could be implanted without complications. Due to the high inflammation a retroprosthetic membrane developed as already seen after implantation of the KPro Type 2. Clinical follow-up still continues. The soft optical part of the Aachen-KPro allows measurements of the IOP with a modified Schiotz tonometer.