Stromal melting associated with a cosmetic contact lens over a boston keratoprosthesis: Treatment with a conjunctival flap

Objectives: The aim was to discuss the use of a conjunctival flap for treatment of keratolysis of a keratoprosthesis (Kpro) donor graft in a patient fitted with a cosmetic contact lens. Methods: Keratolysis developed in the donor graft of a Boston Kpro; this was associated with the use of a cosmetic contact lens. A conjunctival flap was used to stabilize the graft. The literature is reviewed for similar cases, and the rationale for the intervention is described and discussed. Results: Reinforcement of the graft with a conjunctival flap resulted in an arrest in stromal melting and stabilization of visual acuity. Conclusions: Low Dk opaque contact lenses may be a risk factor for keratolysis after Kpro. A conjunctival flap technique can provide stabilization of keratolysis with arrest of corneal melting and merits further study.