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H. F. Chew, B. D. Ayres, K. M. Hammersmith, C. J. Rapuano, P. R. Laibson, J. S. Myers, E. J. Cohen; Boston Keratoprosthesis Outcomes and Complications. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5708.
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To evaluate the clinical outcomes of the Boston Keratoprosthesis at our institution.
A retrospective study was performed. Thirty-six patients received a Boston Keratoprosthesis from August 2005 to October 2007. Outcome measures included device retention rate, pre-operative and post-operative best corrected visual acuities (BCVA), and post-operative complications.
The mean age of all patients was 67.5 years (median 71, range: 24-93). Mean time of follow-up was 12.1 months. Twenty-three patients were male. The primary indication for the Boston Keratoprosthesis was failed penetrating keratoplasty in 28 patients--21 from multiple failed penetrating keratoplasties. Pre-operative comorbidities included glaucoma (26 patients) and limbal stem cell deficiency (10 patients). The main post-operative complications included: retroprosthetic membrane or posterior capsular opacification (22 patients), glaucoma progression (5 patients), corneal melting (4 patients) and endophthalmitis (4 patients). At last follow-up, 35 Keratoprostheses were retained--a Type II through-the-lid Keratoprosthesis extruded and was replaced. The median pre-operative BCVA was hand motions (range: light perception to 20/100). The median BCVA on last follow-up was 20/60 (range: light perception to 20/25). On last follow-up, the BCVA improved in 33 patients, two patients had no improvement, while one had worse vision.
Complications following Keratoprosthesis occur and require careful, frequent follow-up to monitor and treat glaucoma progression, endophthalmitis and inflammation. Despite these potential complications, the Boston Keratoprosthesis provides visual improvement in a patient population with an otherwise poor prognosis.
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