For many patients, corneal transplants offer a way to restore vision following injury or other disease-related and congenital forms of blindness. The traditional method for this procedure is to suture natural human corneal tissue from a donor eye into a recipient eye. In some cases, however, traditional corneal transplants fail, or a patient may not be a good candidate for natural tissue transplant due to special circumstances. When natural cornea transplant is not an option, more and more physicians are recommending artificial corneas (KERATOPROSTHESIS) to restore precious vision.
The University of Rochester’s Dr. James Aquavella is a pioneer in keratoprosthesis. He has played a lead role in researching and developing this procedure to make it safe and has completed more than 200 surgeries on patients from around the world. Currently the Eye Institute uses two different keratoprostheses. The Argus model is a piece of soft plastic – much like a contact lens – that is placed inside the patient’s cornea. It has openings that allow light to pass through the damaged cornea and reach the retina. The second method uses the Boston device. This cylinder-like prosthesis resembles a hard contact lens with an attached tube that it extends into the eye. It projects images by allowing light to pass through the cornea much like a periscope allows a submarine to see from below the surface of the sea. The prosthesis is chosen on a patient-by-patient basis depending on a number of technical considerations determined by the surgeon
With keartoprosthesis, best possible vision is restored quickly and patients often achieve optimum visual levels within a few weeks after the surgery. Because the prosthesis is made of synthetic materials that never totally become incorporated into the body, infection preventing eye drops must be used indefinitely. In addition, during the early months following surgery anti-inflammatory drops are usually required and a protective shield is worn while patients sleep at night.
The surgical procedure is performed on an ambulatory basis with the patient returning home – or to a hotel if the patient is coming from a distance – the same day. Most surgeries are performed with the use of local anesthesia, with the exception of infants and young children where general anesthesia may be indicated. Patients can expect to be in the operating room area for at least three hours for this procedure, including one hour and 20 minutes for surgery as well as pre-operative and recovery time.
In all cases, patients return to the Eye Institute the day following surgery for reevaluation, necessary prescriptions, and post-operative care instructions. Additional follow-up exams are usually made after one week and every three months throughout the first year. For out-of-town patients, follow up visits after the one week interval can be made with a qualified ophthalmologist or corneal specialist who will be in frequent contact with Dr. Aquavella.
Risks and Discomforts
For patients with severe dryness or inflamation, keratoprosthesis can give excellent results but is more risky. In some instances a membrane can develop behind the keratoprosthesis and interfere with vision. This membrane can be opened using a tiny laser beam without requiring additional surgery. Rarely, tissue around the stem of the prosthetic device dissolves which can lead to the leakage of fluid from the eye leading to infection or even vision loss. In such instances the surgery may have to be repeated.
In most cases, the cost of Keratoprosthesis is covered by major U.S. medical insurance plans. You should contact them prior to scheduling surgery to check. For patients who do not have insurance coverage, including foriegn patients, the Eye Institute has a package price of $25,000 U.S. for this procedure. This includes pre-operative visits, clinical testing, surgery, hospital fees and post-operative visits. Travel and out-of-pocket living expenses for out-of-town patients are not included in this fee and patients should plan accordingly.
Contact the StrongVision Faculty Practices at the University of Rochester Eye Institute:
- call (585) 273-EYES (3937)
- or email us with any questions you might have.
Our mailing address is:
The University of Rochester Eye Institute
601 Elmwood Ave. Box 659
Rochester, NY 14642