Visual Outcomes of Boston Keratoprosthesis Implantation as the Primary Penetrating Corneal Procedure

• DOI: 10.1097/ico.0b013e31823f7765
• Publication Date: 2012-02-24T09:39:33Z
• Authors: Joann J. Kang; Jose de la Cruz; Maria Soledad Cor...
• Keywords: Adult; Aged, 80 and over; Male; Visual Acuity; Middle Aged; Corneal Diseases; 3. Good health; Cornea; Prosthesis Implantation; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Humans; Female; Artificial Organs; Aged; Follow-Up Studies; Retrospective Studies

To report the short-term visual outcomes and complications of keratoprosthesis surgery as the primary penetrating corneal procedure for patients at high risk for conventional corneal transplantation.A retrospective chart review was conducted of 21 eyes of 19 patients who underwent either Boston keratoprosthesis type I or type II as the primary penetrating corneal procedure from February 2007 to March 2011.Nineteen type I (90.5%) and 2 type II (9.5%) Boston keratoprosthesis procedures were performed in 19 patients. Mean follow-up was 14.6 months (range, 6-36.3 mo). Primary indications for surgery included chemical or thermal injury, aniridia, and Stevens-Johnson syndrome. Preoperative best-corrected visual acuity (BCVA) ranged from 20/100 to light perception and was count fingers or worse in 20 eyes (95.2%). At last follow-up for all eyes, 15 eyes (71.4%) achieved BCVA≥20/200 and 4 eyes (19%) improved to BCVA≥20/50. No intraoperative complications occurred. Postoperative complications include retroprosthetic membrane formation (47.6%), cystoid macular edema (33.3%), elevated intraocular pressure (23.8%), glaucoma progression (14.3%), and endophthalmitis (4.8%). The initial keratoprosthesis was retained in 19 eyes (90.5%).The Boston keratoprosthesis, based on early follow-up, is a good alternative as a primary penetrating corneal procedure in a select group of patients with very poor prognosis for penetrating keratoplasty. Although complications can occur and require close monitoring, visual acuity significantly improved in the majority of patients.