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Sneha Bontu, Priyanka Chhadva, Jose de la Cruz, Maria Soledad Cortina; Long-term Outcomes of Pediatric Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6318.
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To describe the long-term outcomes of pediatric patients who underwent Boston keratoprosthesis type I implantation (Massachusetts Eye and Ear Infirmary, Boston) at a tertiary care center.
A retrospective review of patient ages 16 and younger who underwent keratoprosthesis implantation between 2008 and 2018 was completed. Eight eyes of 8 patients met inclusion criteria with a minimum follow-up of 6 months. Initial diagnosis, co-morbid ocular conditions, surgical procedures, and post-operative course were analyzed.
Indications for keratoprosthesis implantation included corneal decompensation due to congenital glaucoma (3 eyes, 37.5%), Peter’s anomaly (2 eyes, 25%), aniridia (1 eye, 12.5%), cytomegalovirus (1 eye, 12.5%), and congenital hereditary endothelial dystrophy (1 eye, 12.5%). Comorbid ocular diagnoses include glaucoma (7 eyes, 87.5%) and fetal alcohol syndrome (1 eye, 12.5%). Patients had an average number of 1.5 (range 0 to 4) primary prior transplants. The mean patient age at time of keratoprosthesis transplantation was 8.86±5.26 years (range 0.8 to 15 years) and the average follow-up time was 5.6±3.2 years (range 1.6 to 9.7 years). At 1 year, 7 eyes (87.5%) retained the keratoprosthesis. Complications following keratoprosthesis implantation include retroprosthetic membrane (5 eyes, 62.5%), leakage (1 eye, 12.5%), vitreous hemorrhage (1 eye, 12.5%), extrusion (2 eyes, 25%), symblepharon (1 eye, 12.5%), and corneal melt (3 eyes, 37.5%). Subsequently, the original keratoprosthesis was removed in 5 eyes and replaced by another keratoprosthesis (2 eyes, 25%) or by a penetrating keratoplasty (3 eyes, 37.5%). Preoperative visual acuity ranged from light perception to 20/400, and vision in 3 eyes was fix and follow. At one year, vision improved to 20/150 or better in 2 eyes (25%), vision was stable in 3 eyes (37.5%), and worsened in 2 eyes (25%). At most recent follow up (mean 5.25±3.55 years, range 0.11 to 9.7 years), 2 eyes (25%) had improved vision to 20/80 or better, 2 eyes (25%) were stable at light perception, 1 eye (12.5%) decreased to light perception, whereas 3 eyes (37.5%) lost light perception.
While implantation of Boston type I keratoprosthesis in children is associated with more complications compared to adults, this device offers visual rehabilitation for pediatric patients with corneal decompensation and multiple prior failed transplants.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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