Abstract
Objectives
To report the outcomes of patients who underwent Boston type 1 keratoprosthesis (Kpro)
surgery at the University Health Network (Toronto, Ont.) and the University of Ottawa
Eye Institute (Ottawa, Ont.) between June 2008 and July 2013.
Design
Retrospective case series.
Participants
Forty-four eyes of 43 patients who underwent Kpro surgery.
Methods
A retrospective review was conducted of all Kpro procedures performed by 4 attending
cornea surgeons. The preoperative characteristics and postoperative course of each
patient were analyzed.
Results
In 31 eyes (70%), the primary indication for a Kpro was failed corneal transplantation.
The remaining 13 eyes (30%) had Kpro as a primary procedure. In all eyes, preoperative
visual acuity (VA) was 20/150 or worse, with 39 eyes (89%) having a VA of counting
fingers, hand movement, or light perception. Mean follow-up time was 21 ± 12 months
(range 12–57 months). The retention rate at the last follow-up was 95%. Best-achieved
median VA was 20/100 (range 20/20 to no light perception [NLP]), with 37% of patients
achieving a VA of >20/40 at some point during their postoperative course. At the last
follow-up, median VA was 20/400 (range 20/30 to NLP). The 2 most common complications
included retroprosthetic membrane formation (23 eyes, 52%) and elevated intraocular
pressure (10 eyes, 23%). There were 5 cases (11%) of stromal melt and 1 case (2%)
of infective keratitis.
Conclusions
This study demonstrates that Kpro improves VA in a majority of cases, and is a viable
option in situations in which there is a poor prognosis for traditional penetrating
keratoplasty.
Résumé
Objet
Présenter les résultats obtenus pour des patients qui ont reçu une kératoprothèse
Boston type 1 (KPro) au University Health Network (Toronto, Ontario) et à l’Institut
de l'œil de l'Université d'Ottawa (Ottawa, Ontario) entre juin 2008 et juillet 2013.
Nature
Étude de cas rétrospective.
Participants
44 yeux de 43 patients qui ont subi une chirurgie Kpro.
Méthodes
On a réalisé un examen rétrospectif de toutes les implantations de kératoprothèse
Boston pratiquées par quatre chirurgiens traitants spécialistes de la cornée. Les
caractéristiques préopératoires et la phase postopératoire de chaque patient ont été
analysées.
Résultats
Pour 31 yeux (70 %), l’indication primaire était l’échec d’une greffe de cornée. Pour
les 13 yeux (30 %) restants, la Kpro était pratiquée comme procédure primaire. Pour
tous les yeux, l’acuité visuelle (VA) préopératoire était de 20/150 ou pire, et pour
39 yeux (89 %) l’AV se limitait au compte de doigts, à la distinction d’un mouvement
de la main ou à la perception de la lumière. La durée moyenne du suivi a été de 21
±12 mois (fourchette de 12 à 57 mois). Le taux de rétention au dernier suivi était
de 95 %. La meilleure acuité visuelle médiane obtenue était de 20/100 (portée : 20/20
- aucune perception lumineuse); 37 % des patients ont atteint une AV de >20/40 à un
certain moment durant la phase postopératoire. Au dernier suivi, l’AV médiane était
de 20/400 (portée : 20/30 - aucune perception lumineuse). Les deux complications les
plus courantes étaient la formation d’une membrane rétroprosthétique (23 yeux, 52
%) et l’élévation de la pression intraoculaire (10 yeux, 23 %). Il y a eu 5 cas (11
%) de fonte du stroma et 1 cas (2 %) de kératite infectieuse.
Conclusion
Cette étude démontre que la Kpro améliore l’acuité visuelle dans une majorité de cas
et constitue une option viable dans des situations où le pronostic pour la kératoplastie
transfixiante classique n’est pas bon.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of OphthalmologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The Boston type I keratoprosthesis: improving outcomes and expanding indications.Ophthalmology. 2009; 116: 640-651
- The Boston keratoprosthesis.Int Ophthalmol Clin. 2010; 50: 161-175
- Short-term visual outcomes of Boston type 1 keratoprosthesis implantation.Ophthalmology. 2010; 117: 687-692
- Advances in Boston keratoprosthesis: enhancing retention and prevention of infection and inflammation.Int Ophthalmol Clin. 2007; 47: 61-71
- The Boston keratoprosthesis: a new threadless design.Digit J Ophthalmol. 2007; 13: 6
- Importance of nutrition to corneal grafts when used as a carrier of the Boston keratoprosthesis.Cornea. 2007; 26: 564-568
- Boston type 1 keratoprosthesis: the CHUM experience.Can J Ophthalmol. 2011; 46: 164-168
- Introduction to the use of the Boston keratoprosthesis.Expert Rev. Ophthalmol. 2006; 1: 41-48
- Evaluation and management of glaucoma after keratoprosthesis.Curr Opin Ophthalmol. 2011; 22: 133-136
- Prevalence, progression, and impact of glaucoma on vision after Boston type 1 keratoprosthesis surgery.Am J Ophthalmol. 2012; 153: e1
- Proper method for calculating average visual acuity.J Refract Surg. 1997; 13: 388-391
- Oral buccal mucous membrane allograft with a corneal lamellar graft for the repair of Boston type 1 keratoprosthesis stromal melts.Cornea. 2013; 32: 1516-1519
- Results from the multicenter Boston type 1 keratoprosthesis study.Ophthalmology. 2006; 113: e1
- Boston type 1 keratoprosthesis: the University of California Davis experience.Cornea. 2009; 28: 321-327
- Longer-term vision outcomes and complications with the Boston type 1 keratoprosthesis at the University of California, Davis.Ophthalmology. 2011; 118: 1543-1550
- Boston Keratoprosthesis Type 1 Study Group. Retention of the Boston keratoprosthesis type 1: multicenter study results.Ophthalmology. 2013; 120: 1195-1200
- Boston type 1 keratoprosthesis combined with silicone oil for treatment of hypotony in prephthisical eyes.Cornea. 2011; 30: 1105-1109
- Risk factors for the development of retroprosthetic membranes with Boston keratoprosthesis type 1: multicenter study results.Ophthalmology. 2012; 119: 951-955
- Boston keratoprosthesis outcomes and complications.Cornea. 2009; 28: 989-996
- Glaucoma progression and role of glaucoma surgery in patients with Boston keratoprosthesis.Cornea. 2014; 33: 349-354
- Glaucoma associated with Boston type 1 keratoprosthesis.Cornea. 2012; 31: 134
- Management of glaucoma following Boston keratoprosthesis.Eur Ophthal Rev. 2012; 6: 214-217
- Clinical features and prognosis of Boston type I keratoprosthesis-associated corneal melt.Ocul Immunol Inflamm. 2011; 19: 413-418
- Corneal collagen cross-linking used in the treatment of infectious keratitis.World Ophthalmology Congress of the International Council of Ophthalmologists, Tokyo2014 (http://www.myschedule.jp/woc2014/detail.php?sess_id=869)
- Collagen cross-linking of the Boston keratoprosthesis donor carrier to prevent corneal melting in high-risk patients.Eye Contact Lens. 2014; 40: 376-381
Article info
Publication history
Accepted:
December 6,
2015
Received in revised form:
November 24,
2015
Received:
February 22,
2015
Footnotes
Presented at the 9th Annual Kpro Meeting in Salzburg, Austria, April 12, 2014; the 2014 Annual ASCRS and ASOA Symposia and Congress in Boston, April 25, 2014; and the 2014 Canadian Ophthalmology Society Annual Meeting in Halifax, Canada, June 2014.
Identification
Copyright
© 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
