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Kevin Tozer, Shahzad I Mian; Type I Keratoprosthesis in Stevens-Johnson Syndrome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3148.
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Study the 1 year outcomes of a single-surgeon series of Stevens-Johnson Syndrome (SJS) patients receiving a type I Boston keratoprosthesis (KPRO).
Retrospective chart review of all patients over a 10 year time period with SJS who received a type I KPRO with at least 1 year of follow-up. Primary outcome measure is visual acuity. Secondary outcome measures include graft expulsion, corneal melt, and elevated intraocular pressure.
Of all patients receiving a type KPRO I from 2003 to 2013, 5 eyes from 5 patients with a primary diagnosis of SJS were identified. The average preoperative decimal visual acuity was .01 (Snellen 20/2000) and none had pre-operative glaucoma. At 1 month (dec VA .17, p=.08), 3 months (dec VA .23, p=.14) 6-9 months (dec VA .24 p=.10), and 1 year (dec VA .30, Snellen 20/67, p=.10) post-transplant time points all 5 patients had improved visual acuity, but these differences were not statistically significant. One patient (20%) experienced graft expulsion, corneal melt, and choroidal effusion requiring multiple re-operations. 3 of 5 patients (60%) experienced elevated IOP greater than 20, but all 5 were on some form of pressure lowering treatment and 1 (20%) had a glaucoma drainage device placed concurrently with KPRO placement. One patient had a DVT during the peri-operative period. All patients in the series were given a standard post-operative treatment of prednisolone acetate, vancomycin, and vigamox or ocufloxacin drops.
SJS patients are typically not considered candidates for type I KRPO and instead offered the more invasive and disfiguring type II KPRO. This series, which while small, represents one of the largest studies on SJS patients with type I KPROs. The data shows a trend towards improved visual acuity. One patient attained post-operative visually acuity of 20/25 at 1 year, and 2 others were 20/100 or better. Although risks do exist, as seen in the 1 patient with significant complications, this series suggests that recent advances in peri-operative management may have improved the overall outcomes of SJS patients receiving a type I KPRO. In the future, more ophthalmologists may consider using a type I KPRO in SJS patients.
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