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Todd Driver, Carolina Aravena, Huong Duong, Joseph Christenbury, Fei Yu, Samar Basak, Anthony Aldave; Boston type I Keratoprosthesis as the Primary Penetrating Corneal Procedure. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1315. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Report the long-term outcomes of the Boston type I keratoprosthesis (KPro) as the primary penetrating corneal procedure in patients with a high risk of penetrating keratoplasty (PK) failure.
Retrospective review of all KPro procedures performed by two surgeons between 5/1/04 and 12/31/15. Postoperative outcomes were compared between KPros performed as the primary penetrating corneal procedure (no prior PK) versus following PK failure (prior PK).
262 KPros were implanted in 231 eyes (221 patients); 79 procedures were performed in 67 eyes (63 patients) with no prior PK. The most common indications in eyes with no prior PK were corneal scarring/vascularization (43%), SJS (22%), and chemical/thermal injury (22%). Preop glaucoma was significantly less common in the no prior PK group (39% vs 75%, p<0.0001). While there was no significant difference in the percentage of eyes with preop CDVA ≥20/200 (p=0.36), the percentage was significantly higher in the no prior PK group in each of the first 4 years after surgery (all p≤0.023). The most common postoperative complications for both groups were RPM (48%), PED (28%) and elevated IOP (22%), which was the only complication that was significantly more common in one group (31% in no prior PK group vs 18%, p=0.034). No difference in KPro retention was observed over a mean follow-up period of approximately 3 years (p=0.63).
In eyes in which PK is associated with poor outcomes and in which Kpros have been associated with an increased incidence of postop complications, KPro as the primary penetrating corneal procedure is associated with significantly greater percentage of eyes with CDVA ≥20/200 in the first 4 years, likely due to a significantly lower prevalence of preoperative glaucoma. However, given a significantly higher incidence of postoperative IOP elevation in these eyes, longer follow-up is needed to determine if the difference in CDVA is maintained.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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