This video demonstrates an Eckardt Keratoprosthesis surgery and repair of the retinal detachment in a patient, who presented with a dense corneal blood staining and a complex retinal detachment after a blunt trauma.
Surgeons: Dr. Dasa V. Gangadhar & Dr. Michael Varenhorst, Grene Vision Group, Wichita, Kansas, USA
I’m Dasa Gangadhar. This case is that of a patient who experienced significant blunt trauma. The trauma led to a total hyphema, vitreous hemorrhage, retinal detachment, and a far posterior rupture visualized on imaging studies. Even with an anterior chamber washout, dense corneal blood staining resulted. Hence, a temporary Eckardt Keratoprosthesis is utilized to perform posterior segment repair.
A standard trephination is performed utilizing a Hessburg-Barron vacuum trephine. The densely blood-stained cornea is excised. The Eckardt prosthesis is 7.0 millimeters in diameter. Hence, we utilized a 7.5 millimeter recipient trephine. Too small an opening can complicate insertion. To ensure a watertight seal, either a 7.25 millimeter trephine can be used, or if a 7.5 mm trephine is used, one should create a shelf of posterior cornea by angling the corneal scissors. The shelf can be trimmed as necessary to insert the prosthesis.
Viscoelastic is instilled. And the Eckardt keratoprosthesis is brought onto the field and sutured into place utilizing six 😯 nylon sutures. It is important to remember that the suture passes are placed not through the vertical corneal edge of trephination, but are placed more peripherally with partial thickness bites.
After the Eckardt keratoprosthesis is nicely secured, our retinal colleagues now discover a very complex retinal detachment with multiple posterior breaks. A pars plana lensectomy and vitrectomy is performed, removing dense vitreous blood. After releasing scar tissue brands from the retina, and performing relaxing retinotomies, an air fluid exchange is then performed, allowing for retina to be flattened. Extensive laser is administered around the retinal breaks and at the periphery of the retina.
After these heroic retinal measures, an 80% silicone oil fill follows. The Eckardt keratoprosthesis is now removed after cutting all sutures. Viscoelastic is placed into the anterior segment of the eye and a new cornea is brought onto the field. The cornea is secured using a total of 16 interrupted sutures. Additional oil is added to obtain a full fill.
These are highly complex cases, often handled in a multi-disciplinary fashion. Without intervention, these eyes will be lost. With intervention, we strive to preserve the eye and restore as much vision as possible.
I’m Dr. Dasa Gangadhar, working with Dr. Michael Varenhorst. Thank you for the privilege of your time.