Endothelial Keratoprosthesis In Pseudophakic Corneal Decompensations: Longitudinal Analysis

To evaluate the safety and effectiveness of implanting a novel synthetic corneal endothelial substitute (endothelial keratoprosthesis) in cases with pseudophakic chronic endothelial dysfunction.

A prospective open-label clinical safety & efficacy evaluation, conducted at a tertiary eye care center in south India.

A prospective open-label clinical safety & efficacy evaluation. Endothelial dysfunction following pseudophakic corneal edema which is not associated with systemic diseases like Herpes Simplex or prior corneal surgeries was subjected to a central 6.5 mm synthetic endothelial implantable substitute after a central 7.0mm descemetorhexis & attached with C3F8 gas (85% fill in the AC). Pre & post-operative central pachymetry (in mic.), vision (in ETDRS characters), and pain analog (1-100) were analyzed in addition to re-bubbling rates & toxic reactions due to implants and followed up monthly for 24 months.

12 cases were enrolled. The longest follow-up is 24 months, lowest is 12 months. Baseline vision was 10.54+/-2.2 ETDRS characters, which improved to 41.75+/-8.7 characters by M-1 & retained at  60.72+/-13.1 characters by M-12. Mean Central pachymetry reduced from 720 mic, to 552 mic. by M-1 & maintained at 491 mic. by M-12. The presenting pain was 91.9+/-2.3 & was  7.7+/-2.5 at M-12 (p<0.0001). No immunologic or other adverse reactions were noticed. None were explanted. 4 cases needed re-bubbling (D7, D7, D12 & 21,D7, D14&M3). One subject died after 6 months, postmortem HPE reports revealed epithelialization & fibrosis along the implant edges favoring long-term device retention. 

Endothelial keratoprosthesis improved vision, reduced edema caused in pseudophakic endothelial dysfunctions & was not associated with toxicities until month 12, & is continuously been monitored. Synthetic endothelial substitutes could be an alternative to EK with no risks of rejection events or graft failures, could change the practice pattern of "Transplant to Implant Science".