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Mucous membrane pemphigoid (MMP) with ocular involvement, also referred to as ocular cicatricial pemphigoid, is a rare, autoimmune blistering disease that can have devastating effects for patients. The resulting corneal neovascularization, recurrent corneal abrasions, and ulceration can ultimately result in severe vision loss. We present a 64-year-old man with recalcitrant ocular MMP and consequently advanced corneal involvement that received bilateral keratoprostheses. This case highlights an aggressive but successful placement of bilateral keratoprostheses in recalcitrant ocular MMP, which restored his vision and ultimately his quality of life.

Background:   Corneal afflictions may result in blurred vision, but in severe cases it can cause complete vision loss. In many cases, sight can be restored through a corneal transplant using donor tissues. The problem with transplantation by using donor tissues is the lack of cornea tissues available and a risk of rejection. NanoCurv Impressions has developed a one-piece state of the art artificial corneal device with nanopattern technology. Research is in progress to validate the efficacy of the nanostructures which should improve device integration and prevent infections.

As corneal transplantation has evolved, the spectrum of post-surgical infection has changed and often presents a diagnostic and therapeutic challenge. Lamellar techniques hold the potential of improved outcomes and decreased post-operative complications, however, they create a lamellar interface, which is a potential space for sequestration of infectious organisms. In addition, while keratoprosthesis offers vision to patients who are poor candidates for traditional keratoplasty, infectious complications can be severe and sight threatening. Although antimicrobials remain the mainstay of treatment, definitive management often requires surgical intervention.

A high-speed (100 kHz A-scans/s) complex conjugate resolved 1 μm swept source optical coherence tomography (SS-OCT) system using coherence revival of the light source is suitable for dense three-dimensional (3-D) imaging of the anterior segment. The short acquisition time helps to minimize the influence of motion artifacts. The extended depth range of the SS-OCT system allows topographic analysis of clinically relevant images of the entire depth of the anterior segment of the eye. Patients with the type 1 Boston Keratoprosthesis (KPro) require evaluation of the full anterior segment depth. Current commercially available OCT systems are not suitable for this application due to limited acquisition speed, resolution, and axial imaging range. Moreover, most commonly used research grade and some clinical OCT systems implement a commercially available SS (Axsun) that offers only 3.7 mm imaging range (in air) in its standard configuration. We describe implementation of a common swept laser with built-in k-clock to allow phase stable imaging in both low range and high range, 3.7 and 11.5 mm in air, respectively, without the need to build an external MZI k-clock. As a result, 3-D morphology of the KPro position with respect to the surrounding tissue could be investigated in vivo both at high resolution and with large depth range to achieve noninvasive and precise evaluation of success of the surgical procedure.

A high-speed (100 kHz A-scans/s) complex conjugate resolved 1 μm swept source optical coherence tomography (SS-OCT) system using coherence revival of the light source is suitable for dense three-dimensional (3-D) imaging of the anterior segment. The short acquisition time helps to minimize the influence of motion artifacts. The extended depth range of the SS-OCT system allows topographic analysis of clinically relevant images of the entire depth of the anterior segment of the eye. Patients with the type 1 Boston Keratoprosthesis (KPro) require evaluation of the full anterior segment depth. Current commercially available OCT systems are not suitable for this application due to limited acquisition speed, resolution, and axial imaging range. Moreover, most commonly used research grade and some clinical OCT systems implement a commercially available SS (Axsun) that offers only 3.7 mm imaging range (in air) in its standard configuration. We describe implementation of a common swept laser with built-in k-clock to allow phase stable imaging in both low range and high range, 3.7 and 11.5 mm in air, respectively, without the need to build an external MZI k-clock. As a result, 3-D morphology of the KPro position with respect to the surrounding tissue could be investigated in vivo both at high resolution and with large depth range to achieve noninvasive and precise evaluation of success of the surgical procedure.

We present a high-speed complex conjugate resolved 1 μm swept source optical coherence tomography [SS-OCT] system using coherence revival of the light source for clinical imaging of the anterior segment of the eye. High-speed of 100,000 A-scans/sec and 1 μm imaging window of OCT permits dense 3D imaging of the anterior segment, minimizing the influence of motion artifacts and deep penetration of images for topographic analysis. The swept laser performance with internal clocking was adapted to achieve extended imaging depth requirements. The feasibility of our instrument for visualization of the anterior segment of patients with the Boston Keratoprosthesis (KPro) was discussed. The relations between of the KPro and the surrounding tissue were also demonstrated. © 2013 Copyright SPIE.

We present a high-speed complex conjugate resolved 1 μm swept source optical coherence tomography [SS-OCT] system using coherence revival of the light source for clinical imaging of the anterior segment of the eye. High-speed of 100,000 A-scans/sec and 1 μm imaging window of OCT permits dense 3D imaging of the anterior segment, minimizing the influence of motion artifacts and deep penetration of images for topographic analysis. The swept laser performance with internal clocking was adapted to achieve extended imaging depth requirements. The feasibility of our instrument for visualization of the anterior segment of patients with the Boston Keratoprosthesis (KPro) was discussed. The relations between of the KPro and the surrounding tissue were also demonstrated. © 2013 Copyright SPIE.