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M.-A. Rheaume, M. S. Jardeleza, C. H. Dohlman, L. H. Young; Risk Factors and Incidence of Retinal Detachment Following Boston Keratoprosthesis: A New Insight Into an Old Problem. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1140.
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Retinal detachment after Boston Keratoprosthesis implantation can be devastating for the patient and remains very challenging to manage. Our goal is to better define its associated risk factors and incidence in order to optimize patient care.
A retrospective review of all the charts from patients who had undergone Boston Keratoprosthesis implantation by the same surgeon at the Massachusetts Eye and Ear Infirmary between April 1993 and June 2009 was conducted. Incidence rates of retinal detachment were calculated. Wilcoxon rank sum test and Fisher’s exact test were used to find if there were significant differences between patients who developed a retinal detachment and the rest of the study population.
A total of 205 eyes from 170 patients received a Boston Keratoprosthesis (KPro) during that period of time. The mean number of KPros implanted per eye was 1.3 (range 1-4) with an average follow-up period after the first surgery of 3.9 years. 44 (21.5%) eyes developed a retinal detachment after a mean of 2.6 years (range 1 month to 9.5 years) of follow-up. Significant predictive factors for retinal detachment included the formation of a retro-KPro membrane (p<0.001), the occurrence of sterile vitritis or endophthalmitis after KPro (p<0.001 and p=0.002, respectively), having had a KPro replacement in the same eye (p=0.006) and aqueous humor leak in the postoperative period (p<0.001). Patients who received a KPro because of an autoimmune or systemic disorder affecting their cornea (as opposed to a local pathology) were also found to be at an increased risk of retinal detachment (p<0.001). Lens status at time of surgery, anterior vitrectomy performed at the same time of KPro, tube shunt placement at the same time or after KPro and YAG laser membranectomy or capsulotomy were not found to be predictors for retinal detachment. The calculated incidence of retinal detachment in the entire study population was 8.3% at 1 year. Among all patients who developed a retinal detachment, 14 (32.6%) occurred within the first year after surgery, 26 (60.5%) occurred within 3 years and 37 (86%) occurred within 5 years.
Our data provide the first description of risk factors significantly associated with retinal detachment following Boston Keratoprosthesis. This new information will help improve surgical planning as well as follow-up and treatment of patients identified to be at risk. Knowing the incidence of retinal detachment will prove useful for patient counseling.
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