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Michael A. Klufas, Kristine K. Yin, Nathan M. Radcliffe, Robison V. Chan, Szilard Kiss, Donald J. D'Amico, Jessica B. Ciralsky, Mark I. Rosenblatt, Kimberly C. Sippel, Christopher E. Starr; The Boston Type I Keratoprosthesis: The Weill Cornell Experience. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6070.
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To report the indications, clinical outcomes and complications of patients who underwent Boston type I keratoprosthesis (KPro) surgery at Weill Cornell Medical College.
Retrospective data collection on consecutive Boston type I KPro surgeries performed by four attending cornea surgeons at a large academic medical center between January 2008 and October 2011. Pre-operative and post-operative data were collected by review of electronic patient charts through an institutional review board approved study.
32 Boston type I KPro procedures were performed on 29 eyes of 28 patients. The most common preoperative diagnoses included graft rejection (20 eyes, 68.9%), autoimmune conditions including Stevens-Johnson Syndrome, ocular cicatricial pemphigoid, rheumatoid arthritis, unknown inflammatory condition (7 eyes, 24.1%), pseudophakic bullous keratopathy (6 eyes, 20.7%), and neurotrophic keratopathy (5 eyes, 17.2%). KPro surgery was performed as a primary procedure in 9 eyes (32.1%). Concurrent surgical procedures at the time of KPro surgery included pars plana vitrectomy (65.6%), glaucoma procedures (12.5%) and tarsorrhaphy (12.5%). A known history of glaucoma was present in 20 eyes (68.9%) before surgery. Pre-operative best corrected visual acuity (BCVa) ranged from 20/125 to light perception with 93.5% of eyes with count fingers or worse vision prior to surgery. Mean follow-up was 15.6 months (median 13.4 months, range 1.4 - 43.3 months). Overall, vision improved in 81.3% of KPro procedures. Among eyes with at least 1 year of follow-up, 53.3% had BCVa ≥ 20/200 and 26.7% had BCVa ≥ 20/50. Retention of initial keratoprosthesis was 86.2% at most recent follow-up (4 failures). Repeat Kpro surgery was successfully performed in 2 eyes due to melting and/or extrusion, and our current overall retention rate is 93.1% (27 of 29 eyes). Post-operative complications included retroprosthetic membrane (40.6%), elevated intraocular pressure (56.3%), stromal melting (12.5%), sterile vitritis (6.3%) and infectious endophthalmitis (6.3%).
The Boston type I KPro is a valuable surgical option in eyes with a poor prognosis for penetrating keratoplasty. Our series shows an excellent retention rate with improvement of visual acuity in the majority of patients. Complication and failure rates are similar to other large published series.
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