LAUSR

A 50‐year‐old female with bilateral vascularized corneal opacity and associated limbal stem cell deficiency developed in early childhood following a viral exanthema [Fig. 1a and b] underwent left eye extracapsular cataract extraction with primary implantation of aphakic Auro KPro (Auro KPro cornea; Aurolab, Madurai, Tamil Nadu, India), an Indian version of Boston keratoprosthesis (Boston KPro I; Massachusetts Eye and Ear Infirmary, Boston, MA, USA). There was no clinical evidence of dry eye, trachoma, or cicatricial pemphigoid. Schirmer score was 30 mm. Primary implantation of keratoprosthesis was considered as it was a high‐risk case for graft failure because of heavily vascularized corneal opacity with associated limbal stem‐cell deficiency. A 14‐mm diameter bandage contact lens (BCL) was placed at the end of procedure and was continued in the postoperative period with monthly replacement. During the course, the patient had contact lens losses and BCL was replaced each time. She achieved best‐corrected visual acuity of 6/60 with − 5.00 DS. An area of noncontact, however, was noted from 6 to 9 O’ clock hours between the KPro optic and carrier graft in the immediate postoperative period, evidenced by the presence of air bubble underneath the anterior rim of the optic [Fig. 1c]. Anterior segment optical coherence tomography (ASOCT) (Heidelberg Engineering GmbH, Germany) demonstrated a significant gap and entrapped air bubble [Fig. 1d]. After an initial uneventful clinical course, the patient reported with symptoms of discomfort and watering 4 months postoperatively at which time a localized area of ulceration in the carrier corneal graft at 7 O’ clock was detected [Fig. 1e]. The patient had contact lens loss at that time. Infection was ruled out by taking corneal scrapings from the bed and edges of melt which was negative for bacterial or fungal microorganisms. The area of melt progressively increased despite tarsorrhaphy and tenon’s flap advancement [Fig. 1f].