Presentation on theme: "Only Dropped Kpro…3 Year FU Dr. Quresh B. Maskati Director Cornea Service Maskati Eye Clinic, Bhatia General Hospital."— Presentation transcript:
Only Dropped Kpro…3 Year FU Dr. Quresh B. Maskati Director Cornea Service Maskati Eye Clinic, Bhatia General Hospital
Mr. B. Kabra…56 Years Uneventful 2 stage Pintucci Kpro surgery 1 st stage done by dr. Pintucci Buccal mucosa a bit thick Patient had useful vision 6/18 for 2 years
2 Yrs Post-op.. The Fun Starts The buccal mucosa starts growing over the kpro; Vision drops. Paradise lost! I excise the overgrowth – paradise regained. Vision 6/18 Overgrowth again in 3 months- paradise once more lost Overgrowth excised with Mitomycin C application. Paradise regained!
I Am Annoyed..Patient Is Financially Drained! Overgrowth again. Vision drops to light perception. I decide to cauterize edges of buccal mucosa with heat cautery. Cautery slips from hand, neatly detaches optic from haptic. Optic(PMMA cylinder) drops onto retina. There is 3.5mm hole in cornea through which I can see the optic on retina!
What Can I Do??????? I call ‘friend’ vitreo-retinal surgeon. He refuses to intervene. Says he has never done this sort of thing before! I call dr. Pintucci in Rome- he says he has done 200 cases, never had such a complication. I remember, Dr. Pintucci had done 1 st stage- he always implants a spare Kpro in other lid! I remove 2 nd Kpro, safely lying dormant for 2 years from lower lid of other eye
Necessity Is the Mother of Invention…. I reflect the entire buccal mucosa I suture the haptic of 2 nd kpro through remaining haptic of 1 st kpro and patient’s cornea, allowing the 2 nd kpro optic to occupy the “hole” in the cornea I put back the buccal mucosa (after thinning, of course) I ensure the new optic sticks well out through the 3.5mm hole in the buccal mucosa
Paradise Remains Regained….. It is now 3 years since the 2 nd kpro was implanted. Patient recovered initially 6/24 vision. Patient seen last week, vision has dropped to 6metres- he has been on self medication with steroid drops continuously for 3 years! Fundus clearly visible – 1 st kpro still seen; Optic disc shows glaucomatous pallor. Patient still able to carry out all activities of daily living (ADL).
Moral of the Story…. Dropped optics of kpro are safe as they have no sharp edges unlike IOLs. Perhaps they can be safely left in the vitreous. I pray no one else gets this complication, to confirm the veracity of the above 2 statements!
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