Retention rate and visual outcomes in pediatric patients implanted with the Boston type-1 keratoprosthesis based on pre-operative diagnosis

Abstract

Purpose : Pediatric corneal opacities include diverse clinical entities including congenital and acquired conditions. Keratoprosthesis implantation can provide rapid restoration of a clear visual axis, and thus may be used to prevent dense amblyopia. In order to understand how pre-operative diagnoses may affect the long-term success of these implants, a retrospective chart review was used to determine pediatric Boston type-1 keratoprosthesis retention rates and visual outcomes in patients with congenital versus acquired corneal opacities.

Methods : We conducted a retrospective chart review of pediatric patients implanted with the Boston type-1 keratoprosthesis at the University of Rochester, Flaum Eye Institute between December 7, 2004 and October 14, 2016, including 66 eyes from 51 participants. Data collected included age at surgery, gender, pre-operative diagnosis, length of follow-up, implant retention status, and parental assessment of visual outcome. Patients were divided into groups based on the broad pre-operative distinction of congenital versus acquired corneal opacities. Chi-square tests of independence were conducted to detect differences in implant retention (retained or lost) and visual outcomes compared to pre-operative vision (worse, same, or improved).

Results : Descriptive statistics for study variables are presented in Table 1. The chi-square analyses revealed that there was a significant difference in implant retention, Χ²(1, N = 61) = 4.17, p = .041, and a significant difference in visual outcomes, Χ²(2, N = 60) = 6.27, p = .044, between patients grouped by pre-operative diagnosis (see Table 2). Of the participants with congenital disease, 80.4% retained their keratoprosthesis versus 50% of those with acquired corneal opacity. Assessing visual outcomes, 44% of patients in the congenital group had improved visual outcomes compared to 10% of participants with acquired disease.

Conclusions : Our results indicate that pre-operative diagnosis may influence keratoprosthesis retention and visual outcomes in a pediatric population. Children with congenital opacities were found to have improved retention rates as well as improved visual outcomes compared to those patients with acquired disease. Thus, these outcomes may serve to guide patient selection and inform prognosis as this technology continues to develop.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.