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Joann J. Kang, Maria S. Cortina, Jose De la Cruz; Visual Outcomes of Boston Keratoprosthesis Implantation as the Primary Penetrating Corneal Procedure. Invest. Ophthalmol. Vis. Sci. 2011;52(14):341.
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© ARVO (1962-2015); The Authors (2016-present)
To report the visual outcomes of keratoprosthesis (KPro) surgery as the primary penetrating corneal procedure for patients at high risk for conventional corneal transplantation.
A retrospective chart review was conducted of 69 eyes of 67 patients who underwent either type I or type II Boston KPro surgery from February 2007 to November 2010 at our institution. Of these, 15 eyes of 14 patients underwent KPro as the primary penetrating corneal procedure. The medical records were reviewed to assess preoperative vision, intraoperative and postoperative complications, and uncorrected and best-corrected visual acuities (BCVA).
Fourteen type I (93.3%) and 1 type II (6.7%) Boston KPro procedures were performed in 14 patients, of which, 24 patients (71.4%) were male and mean age was 53.5 years (range 27-74 years). Mean follow-up was 245 days (range 4-812 days). The primary indications for surgery include chemical or thermal injury (5 eyes), Stevens-Johnson syndrome (3 eyes), corneal amyloidosis (2 eyes), aniridia (1 eye), ocular cicatricial pemphigoid (1 eye), lupus with corneal conjunctivalization (1 eye), corneal ulcer (1 eye) and corneal scarring and vascularization of unknown cause (1 eye). Preoperative BCVA ranged from 20/100 to light perception and in 14 eyes (93.3%) vision was counting fingers or worse. No intraoperative complications occurred. Postoperative complications include retroprosthetic membrane (5 eyes), iris at back plate (2 eyes), extrusion of implant (1 eye), high intraocular pressure (1 eye), choroidal detachment (1 eye), vitreous hemorrhage (1 eye) and lower lid retraction (1 eye). Ten eyes (83.3%) achieved BCVA>20/200 and 6 eyes (50%) improved to 20/50 or better at one month follow-up (n=12). At 6 month follow-up (n=8), 7 eyes (87.5%) improved to BCVA>20/200 and 3 eyes (37.5%) were 20/50 or better. At last follow-up for all eyes, 10 eyes (66.7%) achieved BCVA>20/200 and 6 eyes (40%) improved to BCVA >20/50.
The Boston KPro, based on early follow-up, is a good alternative in patients with poor prognosis for primary penetrating keratoplasty. Although complications can occur, visual outcomes improved in the vast majority of patients.
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