Revision of type II Boston keratoprosthesis
Richard C. Allen, MD, PhD
Additional Notes: Length 01:53
Posted March 20, 2017
This is Richard Allen at the University of Iowa. This video demonstrates a revision of a type II Boston keratoprosthesis. Unfortunately, the patient's optic has been covered by the skin and orbicularis muscle. In this case, the patient's tarsus was retained at the initial surgery. Therefore, the remaining tarsus well the removed. A 15 blade is used to make an incision at the inferior border of the tarsus which is able to be palpated. Dissection is then carried out inferiorly between the orbicularis muscle and the orbital septum to the inferior orbital rim. This is being performed in order to mobilize the anterior lamella. The pretarsal orbicularis muscle will then be excised with the overlying skin. The underlying tarsus is then identified. The optic is noted which is surrounded by the tarsus. This case failed because of the retention of the tarsus at the initial case. Attention is then directed superiorly where dissection is carried out between the orbicularis muscle and the orbital septum. The tarsus is then excised from the surface of the globe. Again, the tarsus was retained during the initial surgery which resulted in the optic been covered. The anterior lamella is now able to be mobilized so that suturing it around the optic will allow the optic to be anterior to the skin.
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