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Sotiria Palioura, Bryan Kim, Claes Dohlman, James Chodosh; The Boston Keratoprosthesis Type I in Mucous Membrane Pemphigoid. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3460.
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To evaluate the use of the Boston keratoprosthesis type I implantation in patients with mucous membrane pemphigoid through a retrospective, interventional case series.
Retrospective review of 8 eyes of 8 patients with severe ocular surface disease and corneal blindness due to mucous membrane pemphigoid who underwent Boston keratoprosthesis type I implantation at the Massachusetts Eye and Ear Infirmary from January 1, 2000 through December 31, 2009. Data on preoperative, operative, and postoperative findings were collected. The main outcome measures analyzed were best-corrected visual acuity, keratoprosthesis retention, and postoperative complications. The outcomes were compared with those reported previously on a similar group of patients with mucous membrane pemphigoid who underwent keratoprosthesis type II implantation.
The mean age of patients was 71.3 years (range, 55 to 94 years), and the mean duration of their disease was 6.1 years (range, 1.7 to 11.4 years). Visual acuity after surgery improved to 20/200 or better in 6 eyes (75%) and to 20/40 or better in 3 eyes (37.5%). Only one out of 6 eyes (16.6%) was able to maintain visual acuity of 20/200 or better over a mean follow up period of 3.2 years. In patients with mucous membrane pemphigoid that underwent Boston keratoprosthesis type II implantation, 4 out of 13 eyes (31%) maintained visual acuity of 20/200 or better over a mean follow up period of 3.3 years. Five of the 8 Boston keratoprosthesis type I devices (62.5%) were extruded or had to be replaced during a mean follow up time of 1.7+/-1.7 years, whereas 6 out of the 15 type II devices (40%) were previously reported to require re-implantation or repair over a mean follow up time of 3.5+/-1.7 years. Loss of vision to worse than 20/200 during the follow up period was due to keratoprosthesis type I extrusion, end-stage glaucoma, and retinal or choroidal detachment.
The clinical outcomes of the Boston keratoprosthesis type I in mucous membrane pemphigoid are guarded and, as judged from the literature, less favorable than those of Boston keratoprosthesis type II for the same disease. Reference: 1. Pujari, S., Siddique, S.S., Dohlman, C.H., Chodosh, J. (2011) The Boston Keratoprosthesis Type II: The Massachusetts Eye and Ear Infirmary Experience. Cornea 30, 1298-1303.
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