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Ana Orive, Alaitz Santamaria, Begoña Arana, Barbara Berasategui, Beatriz Jiménez Gómez, Raquel Feijoo, Jaime Etxebarria; Boston Type 1 Keratoprosthesis outcomes and complications, our experience. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3738.
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To evaluate the long term outcomes and complications of the Boston type 1 Keratoprosthesis (KPro) in our institution.
Retrospective case series of all KPro implantation procedures performed at Cruces University Hospital (Bilbao, Spain) between September 2006 and October 2013.
Fifty-six PMMA backplated KPros were implanted in 42 patients. These patients were evaluated with an average follow up of 29,6 months, (median: 25; range: 1 - 86 months). The 54,7% were female, mean age was 53,91 years (median: 57; range: 6 - 87). The primary indication in 11 patients (26,2%) was autoimmune disease followed by chemical burns 9,5% (4 patients) failed penetrating keratoplasty 9,5% (4 patients), radiation after eye or orbital tumor 7,1% (3 patients), herpes simplex virus keratitis 7,1% (3 patients), bullous keratopathy 7,1% (3 patients), other indications were perforation, ictiosis, infectious keratitis… etc. Preoperative visual acuity (VA) ranged from light perception (LP) to 0,2 and was less than or equal to 0,05 in 95,2% patients. 78,5% of the patients experienced an improvement in their visual function after the surgery. Mean best VA was 0,4 (range: LP - 1.0). At the moment 46,5% patients have improved VA, 46,4% have very similar vision comparing to prior KPro surgery and 7,1 % had worse vision. Postoperative complications included: retroprosthetic membrane formed in 41% of the KPro implanted, partial or complete extrusion was noticed in 25% of the KPro most of them in patients affected by autoimmune diseases; postoperatively glaucoma was found in 15 patients (35,7%). Endophthalmitis occurred in 17,8% (n = 10) of the Kpro implanted. Other postoperative complications were: retinal detachment, sterile vitritis, macular cystoid edema and epiretinal membrane. 26,7% KPros required major vitreo-retinal surgery to treat postoperative complications; in addition 3 eyes were eviscerated. Average KPro retention in autoimmune diseases were 21,8 months (range 1 - 86; median: 20 months) and in non autoinmmune diseases were 36,2 months (range: 1 - 86; median: 38,5 months).
KPro provides a rapid visual recovery in patients with an otherwise poor prognosis. In our series several visual loss or failure to improve was due to previous disease or comorbidities. The main challenge with this device is to learn how to avoid and control the complications that can occur.
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