title: Delayed Boston Keratoprosthesis Exchange due to a Preceding Vitreoretinal Surgery with Intraoperative Choroidal Detachment.
abstract: OBJECTIVE
  The aim is to describe the main characteristics of an anterior/posterior segment surgery and how to resolve intraoperative complications. Setting/Venue: The anterior and posterior segment surgical video was created at the Department of Ophthalmology, Virgin Macarena University Hospital, Seville, Spain.
  
  
  METHODS
  We present the case of a male with Stevens-Johnson syndrome and severe limbal deficiency who needed a Boston type 1 keratoprosthesis, reaching a visual acuity of 0.4 (0.05 before surgery). In the course of follow-up, he developed corneal melting with perforation, immune vitritis, and a large epimacular membrane. We decided to perform a 23-gauge vitrectomy associated with keratoprosthesis exchange. As a consequence of inappropriate anesthesia, the patient woke up during the surgery, provoking a retinal tear besides a choroidal detachment. These damages needed endolaser photocoagulation as well as silicone oil tamponade, forcing us to postpone the exchange. An intravitreal dexamethasone implant was also injected. Two months later, the silicone oil was removed, and the Boston keratoprosthesis was replaced by a new type 1 model with a titanium back plate, which likely improves biocompatibility and retention and may reduce complications such as retroprosthetic membranes and stromal corneal melts.
  
  
  RESULTS
  Good anatomical results were achieved, and visual acuity slightly improved to 0.2.
  
  
  CONCLUSIONS
  Combined anterior and posterior segment surgery represents a great challenge that can improve not only visual acuity but also quality of life in patients with severe diseases such as Stevens-Johnson syndrome.
authors.affiliation: Virgin Macarena University Hospital, Seville, Spain.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Relimpio López
authors.forename: María
authors.initials: M
authors.lastname: Gessa Sorroche
authors.forename: Antonio Manuel
authors.initials: AM
authors.lastname: Garrido Hermosilla
authors.forename: Teresa
authors.initials: T
authors.lastname: Laborda Guirao
authors.forename: Francisco
authors.initials: F
authors.lastname: Espejo Arjona
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez de la Rúa Franch
mesh_terms: D001187:Artificial Organs; D001705:Bioprosthesis; D015862:Choroid Diseases / Q000209:etiology* / Q000601:surgery; D003231:Conjunctivitis / Q000601:surgery; D003315:Cornea; D006801:Humans; D007431:Intraoperative Complications; D017075:Laser Coagulation; D008297:Male; D019919:Prosthesis Implantation; D012086:Reoperation; D012167:Retinal Perforations / Q000209:etiology* / Q000601:surgery; D013262:Stevens-Johnson Syndrome / Q000601:surgery; D057586:Vitreoretinal Surgery