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Omar Hassan, Ali R Djalilian, Maria Soledad Cortina; Keratolimbal allograft and Boston keratoprosthesis in management of aniridic keratopathy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2602.
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The Boston keratoprosthesis (KPro) has been utilized in the management of aniridic keratopathy with promising results, but studies comparing outcomes with traditional keratolimbal allograft (KLAL) are limited. We performed a retrospective comparative case series of patients with aniridia receiving surgical treatment for aniridic keratopathy at a tertiary care academic center.
28 eyes with an average age of 44 were analyzed over a mean follow up time of 5.8 years. Patients were divided into 3 groups: KLAL (10 eyes), KLAL followed by KPro (13 eyes), and KPro as the primary procedure (5 eyes). KLAL patients were maintained on systemic immunosuppression. Primary outcome measure was visual acuity at last follow up. The number and type of operations were noted. Finally, details of glaucoma management and complications in both groups were noted.
Average follow up was 69 months (range 4-118) with a starting BCVA of hand motion to 20/100. BCVA at final follow up ranged from NLP to 20/50. These were similar between the three groups. 71% of the eyes showed improvement of BCVA. 90% of those treated with KLAL before KPro showed improvement, 70% of KLAL only eyes improved, and 33% of KPro only eyes improved. The BCVA in the course of follow up for all patients ranged from 20/40 to 20/400. Complications included development of retroprosthetic membranes, need for glaucoma shunt surgery, and penetrating keratoplasties. Patients had an average increase of 1.1 agents to manage their glaucoma. 21% of the eyes required glaucoma shunt surgery. Of note, one patient in the KPro only group was noncompliant with follow up and resulted in loss of vision in the eye.
The majority of eyes in our study maintained vision within at least three lines of the presenting BCVA. Our study shows that adequate outcomes can be achieved with KLAL as a primary intervention in earlier stages of aniridic keratopathy. Failure of the graft can be treated equally with repeat KLAL or secondary KPro with good visual outcomes. Our study also highlights the importance of glaucoma management in these patients. The number of patients in the Kpro only group is too small to perform an adequate comparison and larger studies are needed to determine the best indication for each treatment modality in patients with aniridia.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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