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Alex W. Cohen, Michael D. Wagoner, Anna Kitzman, Kenneth M. Goins; Outcomes of Corneal Transplantation with the Boston Type I Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):348.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the clinical outcomes of Type 1 Boston Keratoprosthesis (Kpro-1)
A retrospective chart review was performed of all Kpro-1 procedures at a tertiary care eye center between January 1, 2008 and August 4, 2010. All cases with more than 3 months of follow up were included in the statistical analysis. Outcome measures were graft retention, visual acuity, and complications.
Thirty seven eyes met the inclusion criteria. The indications for Kpro-1 were failed graft in 28 (75.7%) eyes, Steven Johnson syndrome in 3 (8.1%) eyes, corneal scar in 3 (8.1%) eyes, neurotrophic keratopathy in 2 (5.4%) eyes, and ocular cicatricial pemphigoid in 1 (2.7%) eye. The mean patient age was 61 years (range, 11 to 87). Graft retention occurred in 36 (97.3%) eyes during a mean follow-up period of 32 months (range, 3 to 78). There was a statistically significant improvement in the mean logMAR best corrected visual acuity (BCVA) from 1.704 (range, 0.40 to 1.90) preoperatively to 1.32 (range, -0.07 to 1.90) at the most recent examination (P < 0.001). A final BCVA of ≥ 20/20, ≥ 20/40, or ≥ 20/200 was obtained in 2 (5.4%) eyes, 12 (32.4%) eyes, and 26 (70.3%) eyes, respectively. Overall, the BCVA improved in 29 (78.4%) eyes, remained the same in 4 (10.8%) eyes, and worsened in 4 (10.8%) eyes. One of more major complications occurred in 20 (54.1%) eyes. These included epiretinal membrane in 9 (24.3%) eyes, escalation of glaucoma therapy in 8 (21.6%) eyes, cystoid macular edema in 8 (21.6%) eyes, retroprosthetic membrane in 6 (16.2%) eyes, retinal detachment in 4 (10.8%) eyes, and endophthalmitis in 1 (2.7%) eye. These complications were responsible for the 4 (10.8%) eyes which experienced worsened postoperative vision.
The use of the Kpro-1 is a viable alternative for eyes with a poor prognosis with conventional keratoplasty. Although the sight-threatening complications are common, most eyes retain the keratoprosthesis and experience significantly improved visual acuity after the procedure.
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