Evisceration in patient with type II Boston keratoprosthesis
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 04:12
This video demonstrates an evisceration of a patient who has had a type II keratoprosthesis. Unfortunately, the patient developed an endophthalmitis. The area of the previous tarsorrhaphy is incised with a 15 blade. Dissection is then carried out through the orbicularis muscle to the underlying globe. Dissection is carried out along the surface of the globe posterior to the orbicularis muscle of the eyelids. This is performed 360° around the globe. In the initial surgery at the placement of the keratoprosthesis, the palpebral surface of the conjunctiva as well as bulbar conjunctiva had been excised. The surface of the globe is identified. A measurement is made to determine the border of the keratoprosthesis. This should be approximately 6 millimeters from the center of the prosthesis. Westcott scissors are then used to incise the area of the junction of the keratoprosthesis and the native sclera. The undersurface of the prosthesis is inspected. The globe is then eviscerated with an evisceration spoon. The opaque media is noted secondary to the endophthalmitis. In these patients, a glaucoma drainage device has been placed and this is removed. The inside of the sclera is inspected. Absolute alcohol is used to rub the inside of the sclera to denature any remaining choroid. The posterior surface of the sclera is then incised with a 15 blade. An implant will be placed in the socket in order to give it some fullness. The optic nerve is transected. The anterior sclera is then incised so that an implant can be placed. This implant will be placed posterior to the posterior sclera. This is an 18 millimeter implant. Posterior sclera is then closed with interrupted 4–0 Vicryl sutures. One could make the argument to not place an implant, however this will provide the patient some volume in the area. The anterior sclera is then closed with a running 4–0 Vicryl suture. This results in a double scleral closure over the implant. The edges of the orbicularis are then closed with interrupted buried 5–0 Vicryl sutures. The skin is then closed with a running 7–0 Vicryl suture. At the conclusion of the case, a double eye pad will be placed and erythromycin ointment is placed over the incision. The patient will return approximately one week for reevaluation.
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