Endothelial Cell Density As A Predictor Of Ocular Surface Prosthesis Design In The Visual Rehabilitation Of Penetrating Keratoplasty Michael S. Hughes Perry Rosenthal, M.D. President & Founder, Boston Foundation for Sight Assistant Clinical Professor of Ophthalmology, Harvard Medical School Trisha Hussoin, B.S./B.A. Deborah S. Jacobs, M.D. Medical Director, Boston Foundation for Sight Assistant Clinical Professor of Ophthalmology, Harvard Medical School Faculty, Mass. Eye & Ear Infirmary Cornea Service PR, TH, and DSJ are salaried, full-time employees of the Boston Foundation for Sight, a 501(c)(3) non-profit organization. The authors have no proprietary or financial interest in the Boston Ocular Surface World Cornea Congress VI April 7-9, 2010 Boston, MA
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Michael S. Hughes Perry Rosenthal, M.D. President & Founder, Boston Foundation for Sight
Endothelial Cell Density As A Predictor Of Ocular Surface Prosthesis Design In The Visual Rehabilitation Of Penetrating Keratoplasty. World Cornea Congress VI April 7-9, 2010 Boston, MA. Michael S. Hughes Perry Rosenthal, M.D. President & Founder, Boston Foundation for Sight - PowerPoint PPT Presentation
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Endothelial Cell Density As A Predictor Of Ocular Surface Prosthesis Design In The Visual Rehabilitation Of Penetrating Keratoplasty
Michael S. Hughes
Perry Rosenthal, M.D. President & Founder, Boston Foundation for Sight
Assistant Clinical Professor of Ophthalmology, Harvard Medical School
Trisha Hussoin, B.S./B.A.
Deborah S. Jacobs, M.D. Medical Director, Boston Foundation for Sight
Assistant Clinical Professor of Ophthalmology, Harvard Medical School
Faculty, Mass. Eye & Ear Infirmary Cornea Service
PR, TH, and DSJ are salaried, full-time employees of the Boston Foundation for Sight, a 501(c)(3) non-profit organization.
The authors have no proprietary or financial interest in the Boston Ocular Surface Prosthesis (BOS-P).
World Cornea Congress VIApril 7-9, 2010Boston, MA
Purpose: To evaluate endothelial cell density as a predictor of the need for fenestration in an ocular surface prosthesis in visual rehabilitation of PK.
Methods: A retrospective case review of 96 eyes was performed in 68 consecutive patients seen at this center wearing an ocular surface prosthesis after PK. Fenestrations are used for report of colored haloes associated with micro-cystic epithelial edema. Age, sex, indication for PK, years of graft survival, pseudo-phakia, central pachymetry, endothelial cell density, pre/post-fit BCVA, and fenestration were recorded.
Results: M:F = 37:31 with age 25-89 years. Graft survival range 0.08-40 yrs (mdn=9.4 yrs). 39.6% were pseudo- or aphakic. 75.0% were fitted with fluid-ventilated design; 25.0% required fenestration. Pachymetry in 82/96 eyes was 391.8-700.2 μm, not predictive of fenestration. Endothelial cell densities were 286-3392 cells/mm2. Decreased endothelial cell density (p=0.034) and increased years of graft survival (p=0.007) correlated with need for fenestration. Fitting success rate, ΔBCVA, and wearing status at 6 months are reported.
Conclusion: Endothelial cell density and years of graft survival correlate with need for fenestration in an ocular surface prosthesis in visual rehabilitation of PK. Further study of use of fenestration to improve device tolerance is warranted.
62 y.o. M with Pellucid Marginal Degeneration OD PK # 1 1973, corneal RGP, then scleral, graft failure
PK # 2 2002, 8D of K cyl OS PK # 1 1983, corneal RGP then scleral, 6D of K cyl
20/25, pach 0.540 20/30 “haloes”, pach 0.738
Solution: FENESTRATION 20/25 “no more haloes” 16 h/d wear! Fenestrated BOS-P can delay surgery in high-risk keratoplasty
In standard BOS-P In standard BOS-P
Methods:
Retrospective case review 68 consecutive patients (96 eyes)
Seen at Boston Foundation for Sight, Needham, MA between 7/25/08 - 8/1/09 History of penetrating keratoplasty Fitted with or wearing an ocular surface prosthesis (BOS-P)
For visual rehabilitation For support of ocular surface
Fenestrations were added for report of haloes associated with epithelial edema
Data extracted from medical records Sex Age Indication for penetrating keratoplasty Years of graft survival Phakia
This study was determined to be exempt from review by New England IRB
Central pachymetry Endothelial cell density Visual acuity: pre-BOSP and post-BOS-P Fenestration in prosthesis Fitting success rate
Years of graft survival: 0.08-40 years (median = 9.4 years) Mean years of graft survival for eyes with standard lens: 9.8 Mean years of graft survival for eyes with fenestrated lens: 18.1
There is a significant difference between these means (p < 0.005; t-test)
nstandard = 72 eyes
nfenestrated = 19 eyes
Results:
Design of BOS-P by Years of Graft Survival
Endothelial cell densities: 286-3392 cells/mm2
Mean endothelial cell density of eyes with standard lenses = 1282.49 cells/mm2
Mean endothelial cell density of eyes with fenestrated lenses = 986.09 cells/mm2
There is a significant difference between these means (p < 0.05) Pachymetry (82/96 eyes): 391.8-700.2 μm
There is no difference between the pachymetries in the eyes with standard lenses and the eyes with fenestrated lenses (p = -0.28)