title: Lamellar corneal lenticule graft to treat keratolysis after AlphaCor keratoprosthesis implantation.
abstract: OBJECTIVE
  Clinical assessment of AlphaCor keratoprosthesis and evaluation of surgical method to treat keratolysis in case of stromal necrosis occurrence.
  
  
  METHODS
  This is a noncomparative, retrospective, interventional case series. The medical records of 12 eyes of 12 patients who underwent consecutive AlphaCor keratoprosthesis implantations were reviewed. Patients with severe bilateral corneal pathology unsuitable for a conventional corneal graft, a best-corrected visual acuity (BCVA) from light perception (LP) to 20/200, with no active ocular surface inflammation, controlled intraocular pressure prior to the surgery, and an unstimulated Schirmer test of &gt;2.5 mm at 5 minutes were included. Postoperative medications included topical dexamethasone, ciprofloxacin, and 2% cyclosporine A. Main outcome measures included BCVA and complications occurrence.
  
  
  RESULTS
  After a mean follow-up of 25 ± 12.3 months (range 2-38 months), 8 (66.7%) AlphaCor devices were retained. Postoperative BCVA ranged from LP to 20/63 (mean gain of 2.5 ± 3.1 lines). Seven cases of stromal melt (58.3%) occurred. Three were reversed to penetrating keratoplasty and 3 had a donor corneal layer fixated over the AlphaCor with satisfactory results (mean follow-up 23 ± 1.6 months). There were no instances of endophthalmitis, retinal detachment, or glaucoma exacerbation.
  
  
  CONCLUSIONS
  AlphaCor showed a low incidence of the classic keratoprosthesis complications but a high occurrence of recipient cornea necrosis. Corneal melts were successfully managed in 3 cases by lamellar corneal lenticule graft, thereby increasing the retention of AlphaCor and maintaining BCVA.
authors.affiliation: Ophthalmology Department, Aix-Marseille University - APHM, Hôpital de la Timone, Marseille - France.
authors.forename: Louis
authors.initials: L
authors.lastname: Hoffart
authors.forename: Gérard
authors.initials: G
authors.lastname: Carles
authors.forename: Frédéric
authors.initials: F
authors.lastname: Matonti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003319:Corneal Stroma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology