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Kristine Lo, Kathryn Colby, James Chodosh; Boston type 1 keratoprosthesis: surgical indications, short term retention and achievement of 20/200 vision. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3459.
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The Boston type 1 keratoprosthesis (KPro) is the most commonly used keratoprosthesis in the US and the world,with more than 7,000 implantations to date. A high proportion of candidates for this device are elderly. The objectives of this study are to identify surgical indications,device retention rate at the 3 month postoperative period and the proportion of patients that achieved at least 20/200 vision,which is normally considered the threshold for safe ambulation,in order to predict device “success” for patients later in life who are less likely to experience late complications.
The charts of patients who underwent keratoprosthesis surgery at Massachusetts Eye and Ear Infirmary between January to December 2011 were retrospectively reviewed.
The type 1 KPro was implanted in 28 patients for the first time during the year 2011. Of these 28 patients, 27 had at least 3 months of follow-up data and were included in the analysis. The patients’ age ranged from 37 to 86 years of age with an average of 64.8. 15 (55.5%) patients were over the age of 65. Indications for surgery included failed grafts(66.7%),corneal opacity(14.8%),bullous keratopathy(7.4%),aniridia(3.7%),Stevens Johnson Syndrome(3.7%),and pemphigoid(3.7%). The majority (70.4%) of these patients had prior traditional corneal transplants, but a minority (29.6%) received it as a primary procedure. Of the 27 patients analyzed, 18 (66.7%) achieved at least 20/200 vision within the 3 month postoperative period. Of the 9 patients who did not achieve a postoperative vision of at least 20/200, 8 had preexisting severe retinal disease or glaucoma, which limited visual prognosis. Only 1 of the 9 patients with potential for at least 20/200 vision failed to achieve it, due to a dense retroprosthetic membrane. Of those 15 patients over the age of 65, 10 (66.7%) achieved at least 20/200 vision within the 3 month postoperative period. 100% of the 27 patients retained the keratoprosthesis at the 3 month postoperative period.
Our study demonstrates excellent short term device retention. A majority of the patients achieved at least 20/200 vision within the 3 month postoperative period. The Boston type 1 keratoprosthesis remains a viable option for salvaging vision in older patients with corneal disease in which traditional keratoplasty would carry a poor prognosis.
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