Use Of A Customized Rigid-Gas Permeable Lens As Temporary Keratoprosthesis In Open-Sky Technique For Heterotopic Autokeratoplasty

Ilocos Training & Regional Medical Center, San Fernando, La Union located 269 kilometers north of Manila, Philippines.

A 32-year-old male patient presented with chronic retinal detachment in OD and corneal decompensation in OS. The baseline VA was hand movement with poor light projection and hand movement with good light projection in OD and OS, respectively. An average IOP of 6 mmHg and 12 mmHg in OD and OS, respectively, was noted. The ocular adnexa were unremarkable. Anterior segment findings for OD revealed a clear cornea, with a deep anterior chamber (AC) and surgical aphakia. Specular microscopy of the right eye showed a cell density count of 2290, cell variation of 47, hexagonality of 38, and central corneal thickness of 530. In contrast, the left eye was noted to have a diffusely hazy cornea, almost opaque at the center, deep AC, and prominent corneal neovascularization at the 9 o’clock position. The left eye exhibited corneal decompensation secondary to glaucoma and herpetic keratitis a year prior. The B-scan ultrasonography of OS was unremarkable. Given that the right eye has a healthy cornea with limited visual potential, and the left eye has corneal blindness but a high risk of corneal graft failure due to a highly vascularized cornea, autokeratoplasty was contemplated with the use of temporary keratoprostheses, however, was not readily available and costly. Thus, a customized RGP lens was employed as a substitute for temporary keratoprosthesis. No intraoperative complications were encountered. Postoperatively, corneal clarity and stability were achieved, with a BCVA of 20/125. 

This novel technique utilizing a customized rigid gas-permeable (RGP) lens as an alternative to traditional temporary keratoprosthesis (TKP), has shown promise in maintaining a stable anterior chamber during extensive surgical procedures. Its simplicity, ease of installation, effectiveness, and reusability highlight its significant advantage as an alternative to traditional TKP for future corneal surgeries. However, its current customization process involves significant costs and production time and may inhibit its widespread adoption. Further research and development are needed to determine its long-term benefits, and cost-effectiveness and address the current limitations of its application in corneal surgeries.