Szemészet, 1975 (112. évfolyam, 1-3. szám)
1975 / 3. szám
Szemészet 112. 143—149. 1975. The Filatov Institute, Odessa, USSR Our Experience With Penetrating Keratoprosthesing* Academician, Professor N. A. PUCHKOVSKAYA, Candidate of Medical Siences S. A. YAKIMENKO, Chief of Laboratory of Prosthesing E. A. GOLUBENKO Attempts to use transparent alloplastic material for restoration of vision in patients with corneal leucomas has a more than a 100-year history (Nussbam, 1853; etc.). For a long time, however, alloplasty of the cornea could not justify hopes of opthalmologists because keratoprostheses, as a rule, extruded soon after the operation. V. P. Filatov (1936), who was the first to perform alloplasty of the cornea in our country, wrote: “This way is regarded as finally abandoned”. Significant achievements in the field of corneal transplantation which opened wide ways for restoration of vision in many patients with leucomas also favoured to the weakening of interest to alloplasty. In this connection, it is worth noticing that invaluable contribution into the cause of development of the problem of keratoplasty was made by У. P. Filatov, the 100 th anniversary of whom is widely celebrated this year in our country. However, the presence of so-called “hopeless” leucomas and other lesions of the cornea in which keratoplasty proved to be ineffective made ophthalmologists renew their interest to idea of corneal alloplasty. Lately, a great number of works have appeared which are dedicated to the problem of keratoprosthesing in experiment and humans. (Cardona, 1962,1969; Stone, Yasnda, Refoyo, 1965; Choyce, 1965; Strampelli, 1966; Puchkovs/caya et ál., 1968, 1970, 1973; Bedilo, 1968, 1970; S. Fedorov etal., 1970; etc.) In connection with localization of the opacity it is suggested to perform prosthesing of external, internal or all layers of the cornea; surgical technique, various models of keratoprostheses are elaborated, new materials for their manufacturing are tested, clinical picture of keratoprosthesing is studied, etc. The results obtained demonstrate that in individual cases keratoprostheses can be successfully maintained in the cornea for a rather long period of time and provide high visual acuity. It should be said that existing achievements became possible thanks to development of theoretical understanding of physiology, elaboration of surgical technique, creation of special instruments and synthesis of new polymerous compounds which are relatively easily tolerated by the tissues of the body. Nevertheless there is a significant rate of unfavourable outcomes in alloplastic operations on the cornea and at early terms after operation, significant amount of various complications arising at any time in postoperative period, which require repeated surgical intervention to eliminate them and prevent extrusion of keratoprostheses. This speaks about the fact that keratoprosthesing remains a difficult problem to settle. Since 1967, at the Filatov Institute experimental and clinical studies have been carried out in the field of keratoprosthesing (Puchlcovskaya et al.). In experiments on animals, various constructions of keratoprostheses have been tested, which were manufactured of polymethylmetacrylate, silicone rubber as well as keratoprostheses with optical cylinder of polymethylmetacrylate and fixating tantalum plate. The optical portion of a keratoprosthesis consists of a transparent cylinder, 2—4 mm in diameter and to 4 mm in length. The support* Dedicated to Professor M. Radnót on the 25th anniversary’of her Professorship. 143
