Abstract
Purpose :
To report updated data on long-term complications and visual outcomes after Boston keratoprosthesis type II (BKP 2) implantation in patients with end-stage corneal disease secondary to Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN).
Methods :
This retrospective review evaluated all patients in the Massachusetts Eye and Ear hospital network with SJS/TEN who received BKP 2 implantation between 2000 to 2019. Patients were required to have relevant pre-operative documentation and ≥ 3 months follow up after initial keratoprosthesis implantation. Main outcomes measures included best corrected visual acuity (BCVA), postoperative complications, and device retention.
Results :
Twenty Six eyes of 23 patients underwent BKP2 implantation. Mean follow-up duration was 70.56 ± 62.80 months. Preoperatively, all eyes had count fingers vision or worse. Postoperatively, the best BCVA at any point between initial surgery and most recent follow up was a mean logMAR VA of 0.364 ± 0.677 (Snellen VA ~20/50). Mean BCVA at most recent follow up was 1.67 ± 1.25 (Snellen VA ~20/900). Eleven of 26 eyes had a Snellen VA of ≥ 20/200 at last follow up, with 8 of these ≥ 20/50. Twenty-four of 26 eyes achieved best VA after initial BKP 2 implantation. With each additional BKP 2, the mean BCVA of the cohort was significantly worse. Eight of 26 eyes required repeat BKP 2. Most common concomitant procedures were vitrectomy (96.2%) and Ahmed valve placement (92.3%). The most common post-operative complications were wound dehiscence or leak requiring tarsorrhaphy revision (92.3%), retroprosthetic membrane (RPM) formation (61.5%), endophthalmitis (34.6%) and retinal detachment (30.8%). New-onset or progression of existing glaucoma occurred in 10 of 26 eyes. Eleven of 26 eyes retained their initial BKP 2 device.
Conclusions :
BKP 2 remains an option in treatment of end-stage corneal disease in SJS/TEN when pre-operative vision for both eyes is non-ambulatory. However, complication rates are high and BCVA often deteriorates over time. Unsurprisingly, visual outcomes are worse in SJS/TEN than in other indications for the BKP 2. BKP 2 should only be done at centers with ophthalmologists experienced in this surgery and where the multidisciplinary cornea, glaucoma, and retina care needed can be provided. Counseling patients on prognosis is crucial in deciding to proceed with surgery.
This is a 2020 ARVO Annual Meeting abstract.