Differentiated Approach in Surgical Treatment of Retroprosthetic Membrane in Patients with Keratoprosthesis

Objective: To evaluate the results of a differentiated approach in surgical treatment of patients with retroprosthetic membrane (RPM) after keratoprosthesis implantation. Patients and methods. The study enrolled 26 patients (26 eyes) aged from 32 to 64 years with retroprosthetic membrane after keratoprosthesis implantation. All patients underwent surgical treatment, including keratoprosthesis implantation and surgical removal of the retroprosthetic membrane during different treatment periods. The stage and extent of surgery were determined individually, according to the initial patient’s clinical and functional data, retroprosthetic membrane thickness and previous optical reconstructive operations. Results. All patients had good clinical and functional results. Best corrected visual acuity in the first group was 0.35 ± 0.13, in the second group 0.20 ± 0,15, in the third group 0,15 ± 0,05. Conclusion. Retroprosthetic membrane removal in patients with keratoprosthesis is a complex task with the risk of intra- and postoperative complications at all stages of the treatment. If retroprosthetic membrane is diagnosed in the long-term period after the second stage of keratoprosthesis implantation, ND:YAG-laser discision is preffered; if this technique can not be done or in case of recurrence, surgical excision of the retroprosthetic membrane through the optical cylinder aperture should be performed, but no more than two times. In case of high density of RPM, or RPM combined with severe form of capsular bag fibrosis, or RPM recurrence, microinvasive three-port pars plana vitrectomy with removal of RPM using a vitreotome is recommended.