Purpose:

To describe the surgical technique of a key-hole anterior lamellar graft, combined with cryopreserved, amniotic membrane transplantation for Boston keratoprosthesis (K-Pro) corneal melt.

Methods:

Surgical procedure: After removal of necrotic debris, lamellar corneal graft was trephined and placed between the K-Pro plates. A radial cut was made in the graft and extended to the central circular opening, creating a key-hole. This key-hole lamellar disc was then draped around the central stem of the Boston K-Pro and edges approximated using interrupted 10-0 nylon sutures through the episcleral tissue. Additional fibrin glue was used to secure the graft. Cryopreserved amniotic membrane (AM) was placed over the recipient ocular surface with fibrin glue, and a central opening was also made to match the optic part of the K-Pro to facilitate optimal vision.

Results:

Patient presented with corneal melt around K-Pro. The specialized lamellar keratoplasty was performed and showed uniform attachment of the donor, key-hole, lamellar graft and amniotic tissue to the recipient ocular surface without any debris or air bubbles in the donor-recipient interface. Rapid healing with corneal epithelization and vascularization was noted.

Conclusions:

The use of this novel technique appears to be suitable when faced with a severe K-Pro corneal melt.