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J.J. K. Ma, S. Barnes, C.H. Dohlman; Visual Outcomes in the Boston Keratoprosthesis Type I . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4613.
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Purpose: To examine the efficacy of modifications in the design and management of Boston KPro type I patients on retained visual outcome and identify factors limiting sustained success. Methods: 43 devices were implanted. 24 of these patients had a posterior segment and optic nerve that permitted a vision between 20/200 and 20/20. Herpetic and chemical burn patients were included; only patients with systemic autoimmune disease (SJS, OCP and graft vs. host disease) were excluded. 19 patients had a history of prior graft failures after infection, dystrophies or trauma, 2 were revisions of sub–optimal KPro’s, 3 patients were deemed to be very high risk for keratoplasty. 18 had a pre–existing co–morbid diagnosis of glaucoma. Results: Of the 24 patients who obtained a vision between 20/200 and 20/20, 16 (66.7%) retained a visual acuity above the 20/200 level with a median follow–up time of 17 months (range: 3–33months). The median best–corrected vision for these patients was 20/40. Patients lost vision from: severe trauma (1), endophthalmitis (antibiotic non–compliance) (2), progressive glaucomatous optic neuropathy (3), optic neuropathy of uncertain etiology (1) and choroidal hemorrhage (1). Of these, 4 resulted in loss of light perception. In the 16 patients with retained vision 20/200 or better, 13 required the implantation of a glaucoma drainage device (6 of whom had a device previously implanted for glaucoma prior to the KPro). All patients requiring glaucoma drainage devices had a pre–existing diagnosis of glaucoma prior to KProI implantation. Conclusions: Glaucoma was the most significant cause of vision loss in patients in whom a KProI was able to improve their vision to 20/200 or better.
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