• Long-Term Outcomes of Boston Keratoprosthesis Type II

    By Marianne Doran and selected by George B. Bartley, MD

    Journal Highlights

    Ophthalmology, January 2017

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    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.