Abstract
Purpose :
This study aimed to compare the long-term clinical outcomes in eyes implanted with either the Boston type I keratoprosthesis (Kpro) or the Auro Kpro in a large cohort of patients with bilateral corneal blindness.
Methods :
Methods: This was retrospective comparative interventional case series. The medical records of a consecutive cohort of patients, undergoing Kpro implantation between 2009 and 2016 for bilateral corneal blindness were reviewed. The primary outcome measures were: a) anatomical outcome, defined as retention of the device without extrusion, explantation or exchange; and b) functional success, defined as the duration for which a best-corrected visual acuity (BCVA) of 20/200 or better was maintained. Secondary outcome measures were the rate of postoperative complications.
Results :
Results: The study included 126 eyes of 121 patients; the Boston type I Kpro was implanted in 71 eyes and the Auro Kpro in 55 eyes. Both groups were comparable in terms of baseline characteristics (P>0.3). Chemical burns being the most common indication in both groups. Boston type 1 Kpro group had an overall longer follow-up of 36.7±29.3 months vs. 17.1±16.3 months for the Auro Kpro group although this was not statistically significant (P>0.05). The overall retention rate at 5-years was similar (64.8% vs. 61.82%, P=0.731) in both groups, but the log-rank test comparison of the Kaplan-Mier survival curves demonstrated that eyes with Boston type I Kpro significantly outperformed eyes with the Auro Kpro, in terms of anatomical retention at every postoperative time point (P=0.0222). At 5-years, 82.2% of eyes with a retained Boston type I Kpro maintained a BCVA of 20/200 or better as compared to 51.9% of eyes with retained Auro Kpros (P=0.0122). Although the rate of complications in both groups were comparable, the time to development of complications like retro-prosthetic membranes (RPM) and sterile ulceration, was significantly shorter in eyes with the Auro Kpros (P=0.0034).
Conclusions :
Conclusions: Although with shorter survival expectancy for both device retention and visual acuity, the Auro Kpro device could be considered for patients with specific characteristics, like being from low and middle-income countries, one-eyed, and not able to afford a Boston type I Kpro.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.