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Ashley Dahl, Kristen M. Hawthorne, Bradford Mitchell, Gerald McGwin, John S. Parker; Early Sight Restoration and High Retention after Boston Keratoprosthesis in Non-Autoimmune Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):338.
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To report the success rate of Boston Keratoprosthesis (KPro) in non-autoimmune patients at high risk for primary or repeat corneal transplantation. Treatment was indicated for failed penetrating keratoplasty, corneal perforation, congenital glaucoma and aniridia.
This study was designed as a retrospective medical review of 23 eyes of patients who underwent corneal transplantation with KPro. Preoperative diagnoses, co-morbid conditions, postoperative complications and graft retention rates were evaluated. Visual performance preoperatively and at monthly postoperative visits is the primary outcome reported to evaluate prolonged visual rehabilitation.
Twenty-three eyes of 22 patients had an average of 2.22 prior grafts and an average follow up of 11.7 months after transplantation of KPro. Preoperative diagnoses included failed keratoplasty (17), failed perforated graft (4), bullous keratopathy with extensive anterior synechiae (1), congenital glaucoma (1) and aniridia (1). Preoperative best corrected visual acuity (BCVA) was ≤ count fingers in 91% eyes. Postoperative BCVA, obtained at an average of 3.1 months, was ≥ 20/40 in 35% eyes and ≥ 20/70 in 74% eyes. Visual recovery was maintained throughout the postoperative clinical course with 5 patients followed >20 months, and 60% of those patients retaining BCVA ≥ 20/60. Factors associated with a poorer postoperative visual outcome included preoperative retinal disease (p=0.12) and preoperative or worsening glaucoma (p=0.21). Intraoperative pars plana shunt or shunt revision was associated with a better postoperative visual outcome (p=0.12). Overall, there was a 100% graft retention rate with no cases of endophthalmitis.
Boston Keratoprosthesis yields substantial improvement in visual rehabilitation to non-autoimmune patients who may otherwise be poor candidates for repeat or primary penetrating keratoplasty. Visual recovery is rapid and sustained with a high rate of graft retention; however, preoperative retinal disease or glaucoma may limit patients’ clinical success. Perioperative treatment of glaucoma may lead to better outcomes. Graft retention and infection should not be considered barriers to successful transplantation in these patients.
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