Abstract
Purpose :
In 2004, surgeons at the Flaum Eye Institute at the University of Rochester performed corneal transplantation using the Boston Keratoprosthesis type 1 (BKPro). One of the more recent changes to the procedure involves the use of a conjunctival flap to completely cover the transplant. The use of a conjunctival flap in keratoprosthesis has yet to gain complete traction, and its impact on outcomes of the BKPro procedure have yet to be fully elucidated. We reported the outcomes and complications following Boston Keratoprosthesis type 1 with a conjunctival flap in the pediatric population
Methods :
We performed a retrospective chart review of pediatric patients (<16 years at time of surgery) undergoing KPro implantation with implementation of a conjunctival flap at the Flaum Eye Institute in Rochester, NY, USA. Patients for which there were electronic records available were included in this study. Minimum follow-up time was 6 months. The main outcome measures in this study were visual outcome, device retention, and complications. Demographics and indications for surgery were also gathered.
Results :
The BKPro1 with full-thickness conjunctival flap was performed in 17 eyes of 13 patients aged 1 to 230 months (mean 47 months). Out of 17 implantations, 9 were performed as primary corneal procedures, 5 were performed due to histories of failed corneal transplantations. Best corrected visual acuities prior to surgery ranged from no light perception (NLP) to 4/70. Visual acuities at last follow-up (mean: 26 months, range: 6 months to 51 months) improved in 9 eyes, worsened in 4 eyes, and stayed the same in 4 eyes. Post-operative complications included retroprosthetic membrane formation in 13 eyes and retinal detachment in 4 eyes (mean 23 months post-op). BKPro extrusion occurred in 4 eyes, and mean BKPro implant survival time in this study was 24 months
Conclusions :
Implementation of a full-thickness conjunctival flap has been shown in this study to lead to low implant extrusion rates and improved visual outcomes in a majority of transplant recipients. This may be due to the structural reinforcement the flap provides or its ability to promote healing of the damaged corneal surface it overlays due to its well-vascularized nature. More outcome data is needed to continue optimizing this procedure and to eventually offer the best outcomes to children with corneal defects
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.