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A.-M. Lobo, J. Chodosh, G. N. Papaliodis; Immunosuppresive Therapy With Mycophenolate Mofetil in Patients Receiving the Boston Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1146.
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The Boston keratoprosthesis (Kpro) has revolutionized the treatment of severe ocular surface diseases. In patients with underlying inflammatory etiologies for corneal opacification and limbal stem cell deficiencies, preoperative considerations are imperative in achieving successful outcomes. Immunosuppressive therapy before and after implantation of the Boston Kpro may improve vision and prevent complications. We examine outcomes in Kpro patients treated with mycophenolate mofetil (MM) to control perioperative inflammation.
A retrospective chart review was performed of all patients who were treated with immunosuppressive therapies prior to undergoing placement of the Boston Kpro at the Massachusetts Eye and Ear Infirmary from 2004 through 2010. We identified five patients who were placed on therapy with MM prior to Kpro placement.
Of the five patients identified, all five patients had count fingers vision or worse in their better eye prior to surgery. Four of the five patients underwent Kpro surgery due to ocular surface failure secondary to Stevens-Johnson syndrome (SJS). One patient had severe atopic keratoconjunctivitis with corneal ulceration and multiple failed corneal grafts. All patients were treated with MM at least one month prior to undergoing Kpro surgery. All patients achieved improvement in visual acuity, although follow up times varied. One patient had a wound leak due to corneal melting after starting low dose MM; she underwent Kpro replacement and her MM dose was increased. No patients had significant adverse effects from MM. Prior retinal disease and glaucoma limited visual recovery in two patients.
Historically, Kpro placement in patients with underlying inflammation such as SJS has been fraught with complications such as tissue melting, necrosis and subsequent infection. Compared to other etiologies for ocular surface failure necessitating Kpro placement, patients with chronic inflammation typically do not do as well as those with nonautoimmune conditions. Treatment with immunosuppressive therapies prior to implantation can reduce risk of Kpro failure and vision loss in this group of patients.
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