Long-Term Outcomes of Boston Keratoprosthesis Type II
Ophthalmology, January 2017
Lee et al. conducted a retrospective review of a consecutive clinical case series to assess long-term visual outcomes and complications after implantation of the Boston Keratoprosthesis type II (KPro II). It is considered a treatment of last resort in patients with severe ocular surface disease. Although use of the KPro II presents short- and longer-term challenges, the researchers found that it improved vision in a large proportion of the study patients with otherwise intractable corneal conditions.
The study—the largest and longest single-center case series—involved 48 eyes of 44 patients who underwent KPro type II implantation by 2 surgeons at Massachusetts Eye and Ear between January 1992 and April 2015; mean follow-up was 70.2 months. The most common indications were Stevens-Johnson syndrome (41.7%) and mucous membrane pemphigoid (41.7%). The main outcome measures were visual acuity, postoperative complications, and device retention.
Almost all patients (95.8%; 46 of 48 eyes) had a preoperative visual acuity of ≤20/200. At the last postoperative visit, visual acuity had improved to ≥20/200 in 37.5% (18 eyes) and to ≥20/100 in 33.3% (16 eyes).
The most common postoperative complication was retroprosthetic membrane formation, occurring in 60.4% of eyes. The device extruded or had to be replaced in 50% of eyes. Of particular concern, glaucoma progressed in 27.1% of eyes and was newly diagnosed in 8.3%. Other complications were tarsorrhaphy revision (52.1%), retinal detachment (18.8%), infectious endophthalmitis (6.3%), and choroidal detachment or hemorrhage (8.3%).
The researchers concluded that despite these challenges, the Boston KPro type II is a viable option to salvage vision in patients who have poor prognosis with other corneal procedures.
The original article can be found here.