1. Only Dropped Kpro…3 Year FU Dr. Quresh B. Maskati Director Cornea Service Maskati Eye Clinic, Bhatia General Hospital

2. 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

3. 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!

5. 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!

6. 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

7. 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

9. 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).

10. 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!

11. Thank You for Your Attention!