• Challenges of Type I Boston Keratoprosthesis in Children

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, February 2018

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    The Boston type 1 keratoprosthesis (KPro) has become a viable alternative to traditional penetrating keratoplasty (PKP) to treat severe corneal pathology in adults, but little data exist on its use in children.

    In a multicenter study, Fung et al. documented outcomes and complica­tions of Boston type 1 KPro implan­tation in children and noted that the procedure is associated with multiple challenges and poor outcomes.

    Their study involved reviewing records of patients younger than 17 years of age who underwent KPro surgery at 1 of 3 ophthalmology centers in Canada between January 2010 and November 2014. All procedures were performed by an experienced cornea surgeon. Data were collected and ana­lyzed, including preoperative charac­teristics, intraoperative complications, postoperative complications, device retention, and best-corrected visual acuity (BCVA).

    Before surgery, BCVA ranged from 20/600 to light perception. All of the patients had been diagnosed as having glaucoma, and glaucoma drainage devices (GDDs) had been inserted in 6 eyes before KPro implantation.

    The KPro device was implanted in 11 patients (11 eyes) and was the primary corneal procedure in 6 of them. At the most recent exam (mean follow-up, 41.8 months; range, 6.5-85.0 months), 2 eyes had retained their preoperative BCVA, and 5 eyes lost light perception. Postoperative complications included retroprosthetic membrane (9 eyes), corneal melt (5 eyes), retinal detach­ment (5 eyes), infectious keratitis (3 eyes), endophthalmitis (3 eyes), and GDD erosion (2 eyes). The initial KPro device was retained in only 4 eyes (36.4%).

    This study shows that KPro surgery in children is a major undertaking that can produce permanent and irreversible changes to ocular anatomic features. The authors do not advocate using it in the pediatric population, and all 3 cen­ters involved in this study have stopped offering KPro surgery for children with corneal opacification.

    Because the distance between the lens and cornea is short in children, the procedure routinely requires lensecto­my and anterior vitrectomy and may warrant subtotal iridectomy and GDDs. Therefore, KPro implantation could subject children to lifelong follow-up, long-term use of topical antibiotics, and perpetual risk of sight-threatening complications.

    The original article can be found here.