Peculiarities of Surgical Technique, Clinical and Functional Results of Keratoprosthesis Implantation in Patients after Ineffective Keratoplasty

Objective: To evaluate clinical and functional results of the surgical treatment in patients after ineffective penetrating keratoplasty. Patients and methods. The study enrolled 33 patients (33 eyes) aged from 26 to 79 years after ineffective penetrating keratoplasty. The first group included 15 patients (15 eyes), who underwent the first stage of keratoprosthesis implantation using manual technique of creating the intrastromal pocket under intraoperative AS-OCT control. The second group included 10 patients (10 eyes), who underwent the first stage of keratoprosthesis implantation with creating the intrastromal pocket using a femtosecond laser. The third group included 8 patients (8 eyes), who underwent penetrating rekeratoplasty. Results. Functional results in the study groups were comparable. There were no significant differences in the number of intra- and postoperative complications between three study groups (p < 0.05). However, in the first and third groups, there were more intraoperative complications than in the second group. The significant difference in the number of postoperative complications was also noted: in the first group — 46.7 %, in the second group — 30.0 % and in the third group — 62.5 %. In the first and second groups, the position of the keratoprosthesis intralamellar plate was stable at different follow-up periods. Also, in these groups, after the second stage of keratoprosthesis implantation, vision improved. Vascular leucoma thickness was stable in both groups at all follow-up periods. Conclusion. The first stage of keratoprosthesis implantation can be performed using manual technique of creating the intrastromal pocket or using a femtosecond laser. The standard surgical treatment of patients with vascular leucoma is penetrating keratoplasty, but the high risk of graft failure after each corneal transplantation should be taken into account, especially in patients with vascular leucoma due to burns.

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