Purchase this article with an account.
Sachin Jain, Clement Chow, Jennifer Lim, Lawrence Ulanski, Jose De la Cruz, Maria Cortina, Felix Chau; Retinal Detachments in Eyes After Boston Keratoprosthesis Type 1. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3473.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report the frequency, timing, visual significance, contributing factors, and management of retinal detachment (RD) after successful Boston Keratoprosthesis Type I (KPro) implantation.
A retrospective chart review was conducted of consecutive KPro implantations at a single institution over a 5 year period. Preoperative and postoperative best-corrected visual acuity (BCVA), ocular co-morbidities, anatomic outcomes, surgical interventions, and complications were analyzed.
One hundred and three KPros were implanted into 95 eyes of 94 patients over a 5 year period. Fourteen of the 95 eyes (14.7%) developed RDs during a median follow-up of 27.5 months (range 12-58). Pre-KPro diagnoses included HSV keratitis, chemical burn, aniridia, Peters anomaly, Fuchs’ dystrophy, congenital glaucoma, end-stage glaucoma and limbal stem cell deficiency. Ten of 14 eyes had concomitant surgery, including intraocular lens removal (6), pars plana vitrectomy (PPVx, 5), silicone oil fill (2 for hypotony), Ahmed tube placement (2), pupilloplasty (1) and tarsorrhaphy(1). The median time from KPro placement to occurrence of RD was 9 months (range 0.5-40 months). Thirteen of 14 (92.9%) eyes underwent PPVx; only 3 eyes required KPro removal during RD repair. BCVA prior to KPro surgery was 1.91±0.28 (logarithm of minimum angle of resolution ± standard deviation). BCVA improved after KPro to 1.23±0.58 (p<0.001), but decreased after RD to 2.08±0.31. Ten of 13 eyes (77%) undergoing PPVx for RD achieved initial reattachment. Best BCVA post-repair was 2.02±0.75 overall (p=0.77), and 1.81±0.69 for eyes with successfully attached retinas. (p=0.45) However, 7 of these 10 eyes (70%) developed recurrent RDs and required a median of 2 PPVxs. Complications after KPro identified as contributing to RD included proliferative vitreoretinopathy (7), retroprosthetic membranes (7), hypotony (4), epithelial downgrowth (3), endophthalmitis (3), and choroidal detachment (3). BCVA at final follow-up was 2.19±0.80; 2 of the 14 eyes achieved VA > 20/400 at final follow up.
RD is a significant complication after KPro surgery occurring in 14.7% of 95 eyes. The visual acuity gain after KPro surgery is lost when a retinal detachment occurs, despite good anatomic outcomes in a majority of eyes (77%) after RD repair. Various ocular coexisting co-morbidities and post-KPro complications contributed to RDs and decreased visual acuity.
This PDF is available to Subscribers Only