Miguel A. López M.D., María A. González Reiley M.D.

The authors have no financial interest in the subject matter of this poster.

Biography

Miguel A. López M.D. Cornea Department Head, Hospital Dr. Elias Santana, Santo

Domingo, DR. Education: Universidad Autónoma de Santo Domingo (UASD)

Residency: PG-1 General Surgery - Hosp. Dr. Salvador B. Gautier Ophthalmology Residency - Hosp. Dr. Elías Santana. Fellowship: Cornea , External Eye Diseases and Refractive Surgery -Mass. Eye & Ear Infirmary, Harvard Medical School.

Sociedad Dominicana de Oftalmología: Member and President 2004-2005.

American Academy of Ophthalmology (AAO): International member.

American Society of Cataract and Refractive Surgeons (ASCRS): International member.

Pan-American Association of Ophthalmology: Member.

Biography

Maria A. González Reiley M.D. Fellow of Cornea, External Eye Diseases and Refractive Surgery,

Hospital Dr. Elias Santana, Santo Domingo, DR. Education: Universidad Central de Venezuela (UCV)

Ophthalmology Residency: Hospital Dr. Domingo Luciani, UCV, Caracas, Venezuela.

Fellowship: Cornea, External Eye Diseases and Refractive Surgery - Hospital Dr. Elias Santana, Santo Domingo, DR.

Sociedad Venezolana de Oftalmología: Member. American Society of Cataract and Refractive Surgeons (ASCRS):

International member.

Purpose The chemical burn is a frequent pathology seen in the

Dominican Republic after assault or crimes of passion that causes blindness in most cases.

To evaluate the visual outcomes, follow up and complications of PMMA Keratoprosthesis (KPro) in patients after severe chemical burn at our institution.

Patients and Methods Retrospective case series study. Inclusion criteria: patient with chemical burn grade 4 who had

PMMA Keratoprosthesis implantation in Elias Santana Hospital between June 2006 to July 2009.

Exclusion criteria: posterior segment pathology that affected retina or optic nerve.

Patients and Methods

Variables: age, sex, eye operated, uncorrected distance visual acuity in logMAR pre-op and post-op until 3 years, post-op complications (Dellen, corneal melting, retroprosthetic membrane, iris displacement, device extrusion).

Statistical analysis: Descriptive analysis used median and percentile for continual variables. Percentage for qualitative variables. Bivariable analysis used paired Wilcoxon analysis for statistical significant difference in visual acuities pre and post-op. Lineal multivariable regression to find association between visual acuities and complications in the first year post-op.

ResultsTable 1: Demographic and Affected Eye Baseline Characteristics

Number Percentile Percentile    of Patients Percentage Median 25 75Age (years) 28 25 38Sex

Male 16 89%Female 2 11%

Eye studied

Right 9 50%Left 9 50%

UDVA* Presurgery (LogMAR) 2.6 2 3UDVA* Presurgery (CF† & HM‡) 1 CF† 3 CF† HM‡             * (UDVA) Uncorrected distance visual acuity, † (CF) Counting Fingers, ‡ (HM) Hand Motion

Results

Figure 2: Postoperative Complications

Retroprosthetic membrane was the more common post-op complication (75%), follow by corneal melting (35%), Iris displacement and device extrusion (18%) and corneal dellen (15%). Corneal melting was associated with a higher impaired UDAV at first year post-op (linear multivariable regression p= <0.05).

Results

Figure 1: Uncorrected Distance Visual Acuity long-term changes

Median UDVA was 2.6 LogMAR preoperative and after PMMA Keratoprothesis median UDVA was between 0.7 and 1.0 LogMAR, that keep up until 3 years after the surgery. This indicate significant visual improvement at the first day postop (Paired Wilcoxon Test p=0.001) , with no significant difference between the 1st day and the 3rd year (Paired Wilcoxon Test p=0.89).

Conclusions

PMMA Keratoprosthesis improve visual outcomes for 3 years in patients that otherwise had poor prognosis.

Almost all cases of PMMA K-pro have good device retention.

Corneal melting was the principal factor of impaired UDVA and an adequate contact lens is important to avoid it.

Patient education is important to decrease complications.