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De Wit-Carter G, Hernández-Chavarría C, Navarro-Naranjo PI, Manzanillo-Rosario C, Navarro-Saucedo R, García-Albisua AM, Hernandez-Quintela E, Cabrera-Martínez E, Ordoñez-Ranz G, Sanchez-Huerta V. Boston Keratoprosthesis type 1 (KPro) without contact lens wearing in end-stage corneal disease: The APEC experience. Eur J Ophthalmol 2024; 34:1063-1070. [PMID: 38099653 DOI: 10.1177/11206721231214076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE To report the visual outcomes and survival analysis of keratoprosthesis without contact lens wearing in a tertiary eye care hospital in Mexico City, Asociación Para Evitar La Ceguera (APEC, Coyoacán, México). DESIGN Retrospective cohort with survival analysis. PARTICIPANTS Twenty-three eyes (22 patients) received KPro type 1 between 2015 and 2020 with a follow-up time of three years. METHODS We included analyzed data about past medical history, preoperative diagnosis, best-spectacle visual acuity (BSCVA), postoperative complications and retention rate. Univariate, bivariate and survival analysis were performed and reported. RESULTS The mean age was 58 ± 13.5 years (SD). 60.86% were male patients (14 eyes). Twelve-eyes (52%) achieved a BSCVA of 20/200 or better in the first and second year of follow-up. At 3 years, only 35% achieved 20/200 or better (BSCVA). Retention rate of Boston type 1 KPro was 87% (20 eyes) at 3 years follow-up. The most common complication was retroprosthetic membrane (RPM) which occurred in 9 eyes (39.1%), followed by corneal melting in 7 eyes (30.4%). CONCLUSIONS We report the results of a retrospective cohort of twenty-three eyes (22 patients) who were implanted with a Boston type 1 KPro without contact lens wearing to treat corneal blindness. BSCVA improved significantly in most patients achieving 20/200 or better at the 2-year follow-up. Retention rate was 87%, with the presence of RPM as the most common complication.
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Affiliation(s)
- Guillermo De Wit-Carter
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - César Hernández-Chavarría
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - Pedro-Ivan Navarro-Naranjo
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
- Cornea and External Diseases, Private Solo-Practice, Asociación Médica de Los Andes, Bogotá, Colombia
| | - Cristal Manzanillo-Rosario
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - Ricardo Navarro-Saucedo
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | | | - Everardo Hernandez-Quintela
- Division of Comprehensive Eye Care, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emmanuel Cabrera-Martínez
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - Gabriela Ordoñez-Ranz
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
| | - Valeria Sanchez-Huerta
- Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera, I.A.P., México City, México
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Patel NV, Aggarwal M, Jain M, Gour A, Sangwan V. Dealing With Pericylindrical Melts in Keratoprosthesis: Tenon Patch Graft to the Rescue. Cornea 2024; 43:641-643. [PMID: 38377401 DOI: 10.1097/ico.0000000000003501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/10/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE The aim of this study was to describe the outcomes of autologous Tenon patch graft in the management of Auro keratoprosthesis-related pericylindrical corneal melt. METHODS We report 3 cases of sterile pericylindrical corneal melt in patients with Auro keratoprosthesis implantation after a mean duration of 5 years (1.5-8 years). Case 1 was a patient with severe graft-versus-host disease. Cases 2 and 3 were cases of chemical injury.All these cases of sterile pericylindrical corneal melt (4-6 mm) underwent autologous Tenon patch graft. The technique included freshening of the edges around the melt, followed by measuring the size of the defect. A Tenon graft harvested from the patient's own eye was used to seal the defect and act as a scaffold. The Tenon patch graft was spread over the melt and held in place by the application of fibrin glue and/or interrupted 10-0 nylon sutures. A bandage contact lens was then placed on the eye. RESULTS Tenon patch graft was well taken in all patients. The mean duration of epithelial healing was 1 month. Globe integrity was well maintained with no postoperative complications at a mean follow-up duration of 12 months (6-18 months). CONCLUSIONS Corneal melt is one of the most dreaded complications of KPro because its occurrence could threaten visual prognosis and globe integrity. Autologous Tenon patch is a simple yet innovative and effective option to steer such eyes away from potentially dreadful complications.
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Holland EJ, Cheung AY, Djalilian AR, Farid M, Mannis MJ. Why Are Corneal Specialists Resistant to Treating Patients Who Have Severe Ocular Surface Disease With Limbal Stem Cell Deficiency? Cornea 2023; 42:1063-1068. [PMID: 37535943 DOI: 10.1097/ico.0000000000003322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/05/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE To highlight the paucity of surgeons performing ocular surface stem cell transplantation with systemic immunosuppression (OSSTx with SI) for limbal stem cell deficiency (LSCD) patients, suboptimal treatments for LSCD, and obstacles to adoption. METHODS A review of the Eye Bank Association of America annual reports and the authors' case volume for OSSTx with SI was performed. Examination of the published literature on corneal surgeries, especially for LSCD, was completed. These findings were combined with our clinical observations to develop this editorial. RESULTS Despite techniques and protocols for OSSTx with SI published more than 30 years ago for the treatment of severe bilateral LSCD, only a small number of corneal specialists have adopted these techniques. There is a paucity of attention to this population of patients, with minimal publications to advance this area of our field. We are too often referred patients with LSCD and severe ocular surface disease that have had suboptimal treatments such as penetrating keratoplasties or primary keratoprostheses. Hesitancy for adopting OSSTx with SI is likely due to a lack of exposure to these procedures during training and fear of systemic immunosuppression. Corneal surgeons are likely unaware of the safety of systemic immunosuppression with appropriate monitoring especially when comanaging these patients with an organ transplant specialist. CONCLUSION There is a large unmet need for the treatment of corneal blindness secondary to conjunctival and LSCD. For the vast majority of patients, OSSTx should be the first surgical choice to treat these eyes. We hope major ophthalmology centers will meet this need by building programs, and groups of corneal surgeons should collaborate to create regional centers to make this treatment more accessible to help this population.
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Affiliation(s)
- Edward J Holland
- Cincinnati Eye Institute/University of Cincinnati, Cincinnati, OH
| | | | - Ali R Djalilian
- The University of Illinois, College of Medicine, Chicago, IL
| | - Marjan Farid
- Gavin Herbert Eye Institute, UC Irvine, Irvine, CA; and
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Arboleda A, Phansalkar R, Amescua G, Lee WS, Brandt JD, Mannis MJ, Kossler AL, Lin CC. Preparing the Ocular Surface for a Boston Keratoprosthesis Type 1 Through En Bloc Minor Salivary Gland Transplantation and Mucous Membrane Grafting in End-Stage Stevens-Johnson Syndrome. Cornea 2023; 42:912-916. [PMID: 37159138 PMCID: PMC10247429 DOI: 10.1097/ico.0000000000003262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/15/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE This case describes the successful visual restoration of a patient with end-stage Stevens-Johnson syndrome (SJS) with a severely keratinized ocular surface. METHODS This study is a case report. RESULTS A 67-year-old man with SJS secondary to allopurinol sought visual rehabilitation options. His ocular surface was severely compromised from sequelae of chronic SJS, leaving him with light perception vision bilaterally. The left eye was completely keratinized with severe ankyloblepharon. The right eye had failed penetrating keratoplasty, limbal stem cell deficiency, and a keratinized ocular surface. The patient declined both a Boston type 2 keratoprosthesis and a modified osteo-odonto keratoprosthesis. Therefore, a staged approach was pursued with (1) systemic methotrexate to control ocular surface inflammation, (2) minor salivary gland transplant to increase ocular surface lubrication, (3) lid margin mucous membrane graft to reduce keratinization, and finally, (4) Boston type 1 keratoprosthesis for visual restoration. After minor salivary gland transplant and mucous membrane graft, the Schirmer score improved from 0 mm to 3 mm with improvement in ocular surface keratinization. This approach successfully restored the vision to 20/60, and the patient has retained the keratoprosthesis for over 2 years. CONCLUSIONS Sight restoration options are limited in patients with end-stage SJS with a keratinized ocular surface, aqueous and mucin deficiency, corneal opacification, and limbal stem cell deficiency. This case demonstrates successful ocular surface rehabilitation and vision restoration in such a patient through a multifaceted approach that resulted in successful implantation and retention of a Boston type 1 keratoprosthesis.
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Affiliation(s)
- Alejandro Arboleda
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA
| | | | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Wen-Shin Lee
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA
| | - James D Brandt
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA
| | - Mark J Mannis
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA
| | - Andrea L Kossler
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA
| | - Charles C Lin
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA
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Retinal Detachment in Eyes with Boston Type 1 Keratoprosthesis: Surgical Techniques and Mid-Term Outcomes. Retina 2021; 42:957-966. [PMID: 34954778 DOI: 10.1097/iae.0000000000003389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the mid-term outcomes of pars plana vitrectomy (PPV) performed for retinal detachment (RD) repair after Boston type 1 keratoprosthesis (KPro) implantation. METHODS Retrospective chart review of KPro implanted at the Stein Eye Institute presenting with RD and treated by PPV. Functional success was defined as a postoperative visual acuity (VA) maintained within 2 Snellen lines of the CDVA measured before the development of the RD (baseline) and anatomical success as an attached retina after the PPV. Kaplan-Meyer survival analyses were performed. RESULTS Among the 224 KPro performed, 28 (15.2%) RD were identified, of which 21 (9.4%) were included. The mean follow-up was 42.5 ± 27.3 months. Vitreoretinal proliferation was present in 18/21 (85.7%) eyes. Surgical techniques were adapted to the complex anterior segment anatomy of KPro eyes. Anatomical success was achieved in 18/21 (85.7%) eyes. Functional success occurred in 17/21 (81.0%) eyes, and 5/21 (23.8%) eyes reached 20/400 or better VA at final follow-up. The KPro was retained in 11/21 (52.4%) eyes. The retention rate decreased from 94.7% at 1 year to 53.5% at 5 years. The most frequent complications were retroprosthetic membrane (47.6%) and corneal melt (23.8%). CONCLUSION Modified PPV techniques resulted in relatively good mid-term anatomic, functional, and retention rate outcomes, given the severity of RD at presentation, and the numerous preoperative comorbidities of KPro eyes.
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Bonnet C, Chehaibou I, Chen A, Bourges JL, Markovic D, Hubschman JP, Aldave AJ. POSTOPERATIVE POSTERIOR SEGMENT COMPLICATIONS AFTER BOSTON TYPE 1 KERATOPROSTHESIS: Incidence, Risk Factors, and Intermediate-Term Outcomes. Retina 2021; 41:2499-2509. [PMID: 34111883 DOI: 10.1097/iae.0000000000003233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify the incidence of, risk factors for, and outcomes of posterior segment complications (PSC) after Boston Type 1 keratoprosthesis (KPro) implantation. METHODS Retrospective, consecutive case series of KPro procedures at the Stein Eye Institute. Data regarding ocular history, intraoperative details, postoperative management, and outcomes were collected. Eyes with at least one PSC (PSC group) were compared with eyes without PSC (No PSC group), and risk factors for PSC were determined. RESULTS Ninety-five PSC occurred in 69/169 eyes (40.8%), at a mean of 20.1 months after KPro implantation (0.01 complications/eye month). The median follow-up after KPro implantation was 44.0 months (range 3.0-174.4). The most common PSC were epiretinal membrane (16.6%), cystoid macular edema (12.4%), vitritis (11.2%), and retinal detachment (9.5%). Previous retinal detachment repair, concomitant intraocular lens removal, postoperative aphakia, and vitritis were risk factors for retinal detachment. Postoperative infectious keratitis was a risk factor for epiretinal membrane, cystoid macular edema, and vitritis. The posterior segment complication group had a significantly higher rate of eyes failing to maintain visual acuity ≥20/200 (HR = 2.28; 95% CI = 1.35-3.85) and KPro retention failure rate (HR = 1.66; 95% CI = 0.95-2.91). CONCLUSION Posterior segment complications occur in approximately 40% of eyes after KPro implantation, resulting in reduced visual outcomes and KPro retention.
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Affiliation(s)
- Clémence Bonnet
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
- Ophthalmology Department, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Ismael Chehaibou
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
- Ophthalmology Department, Université de Paris, AP-HP, Hôpital Lariboisière, Paris; and
| | - Angela Chen
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jean-Louis Bourges
- Ophthalmology Department, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Daniela Markovic
- Department of Medicine Statistics Core, University of California, Los Angeles, California
| | - Jean-Pierre Hubschman
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Anthony J Aldave
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
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John T, Tighe S, Sheha H. Keyhole Anterior Lamellar Keratoplasty for Boston Keratoprosthesis Corneal Melt. Clin Ophthalmol 2021; 15:3993-3996. [PMID: 34629863 PMCID: PMC8495233 DOI: 10.2147/opth.s326306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
Abstract
Corneal melt remains a challenging complication of Boston keratoprosthesis (KPro) and may lead to disastrous consequences such as endophthalmitis, KPro extrusion, and permanent loss of vision. Several procedures have been suggested to repair established melts; however, KPro removal or exchange is often required due to high recurrence. We herein describe a novel surgical technique to repair corneal melt: a lamellar corneal graft is centrally trephined, and a radial cut is extended from the central opening to create a keyhole graft. The graft is draped around the KPro and tightly secured around the central stem. The radial cut is closed with sutures, and the graft is secured into the underlying tissue with fibrin glue and sutures. The graft remains stable with the KPro in place, while the patients maintain a 20/200 vision or better at two years. This technique is a useful alternative for securing KPro and preventing corneal melt recurrence.
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Affiliation(s)
- Thomas John
- Thomas John Vision Institute, Tinley Park, IL, USA.,Department of Ophthalmology, Loyola University at Chicago, Maywood, IL, USA
| | - Sean Tighe
- Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL, USA.,Department of Ophthalmology, Florida International University Herbert Wertheim College of Medicine & Glaucoma Research Organization, Miami, FL, USA
| | - Hosam Sheha
- Department of Ophthalmology, Florida International University Herbert Wertheim College of Medicine & Glaucoma Research Organization, Miami, FL, USA.,Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Hofstra Northwell School of Medicine, New York, NY, USA
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Bostan C, Nayman T, Szigiato AA, Morfeq H, Harissi-Dagher M. Endophthalmitis in Eyes With the Boston Type I Keratoprosthesis: Incidence, Recurrence, Risk Factors, and Outcomes. Cornea 2021; 40:1258-1266. [PMID: 33394754 DOI: 10.1097/ico.0000000000002641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the incidence and recurrence of Boston type I keratoprosthesis (KPro)-associated endophthalmitis, and its microbiological profile, risk factors, and outcomes. METHODS This is a retrospective study of 158 consecutive KPro procedures with a median follow-up of 78.4 months. Medical charts were reviewed for ocular history, contact lens and topical antibiotic use, visual acuity, and complications. For eyes with endophthalmitis, time to infection, culture results, and recurrences were collected. Cox regression analyses identified risk factors for endophthalmitis and compared the risk for visual failure, KPro retention, and globe loss between eyes with and without endophthalmitis. RESULTS The incidence and recurrence rates of endophthalmitis were of 1.7% and 6.0% per procedure-year, respectively. First episodes occurred at a median of 18.6 months. Eight of 18 episodes (44%) were culture positive, isolating mainly Gram-positive bacteria (7 [88%]). Previous ocular burn (hazard ratio: 7.34, 95% confidence interval: 1.91-28.15), infectious keratitis (5.09, 1.70-15.22), corneal melt (4.55, 1.50-13.83), and postoperative contact lens wear (4.19, 1.17-15.04) were risk factors. Eyes with endophthalmitis did not have a higher risk for visual failure (1.74, 0.78-3.91) but were more likely to not retain the KPro (2.81, 1.15-6.88) and undergo evisceration (2.81, 1.15-6.88). All eyes lost ≥ 2 lines of vision during the endophthalmitis episode. CONCLUSIONS Endophthalmitis is rare but vision and globe threatening in eyes with KPro. Given the increased associated risk, corneal melts and infectious keratitis must be promptly treated, postoperative contact lenses should be considered on a case-by-case basis, and patients with ocular burns might require more aggressive antimicrobial prophylaxis.
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Affiliation(s)
- Cristina Bostan
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
| | - Taylor Nayman
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
| | | | - Hussein Morfeq
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
- Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
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Abstract
PURPOSE OF REVIEW The Boston Keratoprosthesis Type 1 was pioneered by Claes Dohlman several decades ago. Since its inception, the device has undergone multiple revisions to address challenges associated with retroprosthetic membrane formation, retention, extrusion, stromal melt and endophthalmitis. Although visual outcomes and retention rates have improved, challenges, especially glaucoma, remain. RECENT FINDINGS The Boston Keratoprosthesis Type I device has seen an increase in popularity because of the improvement in rates of retention and visual rehabilitation. Recent outcome studies have allowed clinicians to identify diagnoses and indications that can lead to more favorable results with the Boston Keratoprosthesis Type I device. SUMMARY The Boston Keratoprosthesis Type I device continues to play a vital role in visual rehabilitation for eyes with very low chance of realistic allograft survival -- such as in eyes where corneal grafting is considered high-risk: eyes with corneal limbal stem cell failure, extensive deep corneal stromal neovascularization, and multiple allograft failures. This review article summarizes the perioperative and postoperative challenges, as well as other considerations associated with the device.
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Schaub F, Matthaei M, Enders P, Siebelmann S, Hos D, Bachmann BO, Cursiefen C. [Treatment of vascularized high-risk eyes with a Boston keratoprosthesis]. Ophthalmologe 2021; 118:544-552. [PMID: 33730307 DOI: 10.1007/s00347-021-01356-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In severely compromised and vascularized high-risk eyes, the Boston keratoprosthesis procedure is often the last treatment option. The transparency of the optics is not impaired by endothelial immune reactions. METHODS This review article discusses relevant literature as well as our own data and experiences with the Boston keratoprosthesis in high-risk eyes. The relevant complications as well as the postoperative management are discussed. RESULTS In more than 60% of the high-risk eyes a long-term increase in visual acuity can be achieved. Keratoprosthesis retention rates show a variable span with reported mean 5‑year retention rates of 75%. The most common postoperative complications include the formation of a retroprosthetic membrane and keratolysis in up to 50% each. More than 70% of the eyes already suffer from (secondary) glaucoma preoperatively, so that glaucoma surgery is performed simultaneously in at least 20% of cases and in the postoperative course further antiglaucomatous surgery is necessary in up to 31%. Vitreoretinal complications include, in particular, sterile vitritis and infectious endophthalmitis but persistent hypotonia is also described in one third of patients. CONCLUSION The Boston keratoprosthesis is an alternative to conventional corneal replacement if the prognosis for allogeneic transplants is poor. Postoperative complications are common; therefore, postoperative management plays an important role. For vascularized high-risk eyes, however, it is often the only remaining option for visual rehabilitation.
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Affiliation(s)
- F Schaub
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
| | - M Matthaei
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - P Enders
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Glaucoma Imaging Center University of Cologne, Medizinische Fakultät, Universitätsklinik Köln, Köln, Deutschland
| | - S Siebelmann
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - D Hos
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Zentrum für Molekulare Medizin Köln, Universität zu Köln, Köln, Deutschland
| | - B O Bachmann
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - C Cursiefen
- Zentrum für Augenheilkunde, Medizinische Fakultät, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Zentrum für Molekulare Medizin Köln, Universität zu Köln, Köln, Deutschland
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El-Khoury J, Mustafa M, Daoud R, Harissi-Dagher M. Time to achieve best postoperative visual acuity following Boston keratoprosthesis surgery. Br J Ophthalmol 2021; 106:929-934. [PMID: 33658233 DOI: 10.1136/bjophthalmol-2020-317483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/23/2020] [Accepted: 01/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To evaluate the time needed for patients with Boston type 1 keratoprosthesis (KPro) to reach their best-corrected visual acuity (BCVA) and all contributing factors. METHODS We retrospectively reviewed 137 consecutive eyes from 118 patients, measured how long they needed to reach their BCVA and looked at factors that might affect this time duration including patient demographics, ocular comorbidities and postoperative complications. RESULTS The mean follow-up was 5.49 years. The median time to BCVA postoperatively was 6 months, with 47% of patients achieving their BCVA by 3 months. The mean best achieved logMAR visual acuity was 0.71, representing a gain of 6 lines on the Snellen visual acuity chart. Postoperative glaucoma, retroprosthetic membrane (RPM) and endophthalmitis prolonged this duration. We found no correlation between the following factors and time to BCVA: gender, age, indication for KPro surgery, primary versus secondary KPro, number of previous penetrating keratoplasties, previous retinal surgery, intraoperative anterior vitrectomy and preoperative glaucoma. CONCLUSION In our retrospective cohort, the majority of subjects reached their BCVA between 3 and 6 months after KPro implantation. This duration was significantly prolonged by the development of postoperative glaucoma, RPM and endophthalmitis.
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Affiliation(s)
- Jonathan El-Khoury
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Majd Mustafa
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Roy Daoud
- Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
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Bouhout S, Robert MC, Harissi-Dagher M. Mid-term prognosis of type I Boston keratoprosthesis reimplantation. Br J Ophthalmol 2020; 106:37-41. [DOI: 10.1136/bjophthalmol-2020-317598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/02/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
AimTo examine the mid-term visual and anatomical prognosis of patients who require reimplantation of a second Boston keratoprosthesis type 1 (B-KPro).MethodsRetrospective observational case series of 122 patients (141 eyes) who received a B-KPro at a single institution were reviewed. Eyes that underwent a second B-KPro were included in the study. Primary endpoints were B-KPro retention, final visual acuity 20/200 and loss of light perception. Secondary endpoints included the occurrence of postoperative complications.ResultsSeventeen eyes (12%) required a B-KPro reimplantation. Corneal melt was the most common indication for replacement (88%). Mean follow-up time after the second B-KPro was 4.4±2.1 years. The Kaplan-Meier analysis estimated the second B-KPro retention rate at 79% over 8 years. Retroprosthetic membrane (RPM, 53%) was the most common complication. Forty-one per cent of the eyes suffered from corneal melt following their second B-KPro. One year after the second B-KPro, 47% of the patients retained a vision 20/200. Seven eyes (41.2%) lost light perception, which was secondary to an inoperable retinal detachment in five cases. Four eyes (24%) developed phthisis following inoperable retinal detachment (n=3) or endophthalmitis (n=1).ConclusionB-KPro reimplantation is a potentially sight- and globe-saving procedure for eyes with B-KPro failure, but the prognosis is guarded. B-KPro reimplantation can salvage ambulatory vision in a third of patients while another third of patients progress to loss of light perception. RPM and retinal detachment were important obstacles to visual rehabilitation while recurrent corneal melt was responsible for most cases of anatomical failure.
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Daoud R, Sabeti S, Harissi-Dagher M. Management of corneal melt in patients with Boston Keratoprosthesis Type 1: Repair versus repeat. Ocul Surf 2020; 18:713-717. [DOI: 10.1016/j.jtos.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 01/10/2023]
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Comparison of the Clinical Efficacy of Boston Keratoprosthesis Type I and Repetitive Penetrating Keratoplasty for Refractory Keratopathy. J Craniofac Surg 2020; 31:e194-e199. [PMID: 31977683 DOI: 10.1097/scs.0000000000006164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare the clinical efficacy of Boston Keratoprosthesis type I (B-KProI) and penetrating keratoplasty (PKP) for patients with refractory keratopathy after 1failed PKP in China. METHOD The 42 consecutive cases with refractory keratopathy after 1 failed PKP, from July 2010 to December 2014, were divided into 2 groups according to the surgical method: KPro group (n = 21) and PKP group (n = 21). Visual acuity (LogMAR), corneal graft transparency, postoperative complications and corneal graft survival rate were observed. The follow-up time was 2 years. The Kaplan-Meier curve was used to analyze the survival rate of the two groups of corneal grafts. RESULTS The average best corrected visual acuity (BCVA) at 1, 6, 12, 18, and 24 months in KPro group were significantly lower than PKP group (P < 0.01). The best postoperative visual acuity and BCVA at postoperative 2 years in KPro group were lower than PKP group. The success rate of KPro group (86%) were significantly higher than PKP group (43%) (P < 0.01). There were no significant differences in indicate of complications in 2 groups including secondary glaucoma, secondary infectious corneal ulcer, corneal graft melting and endophthalmitis (P > 0.05). CONCLUSION Compared with repetitive PKP, B-KProI had a higher success rate, improved postoperative visual acuity, reduced postoperative corneal transplant rejection rates and improved corneal graft survival rate.
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Nonpassopon M, Niparugs M, Cortina MS. Boston Type 1 Keratoprosthesis: Updated Perspectives. Clin Ophthalmol 2020; 14:1189-1200. [PMID: 32425503 PMCID: PMC7196770 DOI: 10.2147/opth.s219270] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022] Open
Abstract
The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.
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Affiliation(s)
- Manachai Nonpassopon
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Muanploy Niparugs
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Department of Ophthalmology, Faculty of Medicine, Chaing Mai University, Chaing Mai, Thailand
| | - Maria Soledad Cortina
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Zhu BB, Zhou J, Zheng J, Zhang Y, Wan T, Huang XD, Lin L, Jin XM. Corneal graft melting: a systematic review. Int J Ophthalmol 2020; 13:493-502. [PMID: 32309189 DOI: 10.18240/ijo.2020.03.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/20/2019] [Indexed: 12/22/2022] Open
Abstract
Corneal graft melting is a severe complication of keratoplasty. This review is to summarize the incidence, the pathogenesis, the risk factors, the prognosis and the prevention of corneal graft melting after keratoplasty. We systematically searched PubMed, Web of Science and WanFang database to retrieve potentially eligible articles about relevant clinical reports and animal experiments. We read the full texts to identify eligible articles. The selection of studies and data extraction were performed independently by two reviewers. In conclusion, the pathogenesis of corneal graft melting is complicated, and many risk factors are closely related to corneal graft melting. Analysis of pathogenesis and risk factors of corneal graft melting can facilitate the development of targeted therapies to better guide clinical practice.
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Affiliation(s)
- Bin-Bin Zhu
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Jie Zhou
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Jiao Zheng
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Yue Zhang
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Ting Wan
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Dan Huang
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Lin Lin
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Xiu-Ming Jin
- Eye Center, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Harissi-Dagher M, Awad Y. Comments on: Keratoprosthesis optic and carrier corneal graft “noncontact” as a cause of sterile stromal necrosis in a case of Auro KPro implantation. Indian J Ophthalmol 2020; 68:266. [PMID: 31856553 PMCID: PMC6951166 DOI: 10.4103/ijo.ijo_1201_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Moyal L, Adam R, Boumendil J, Meney J, Rodallec T, Akesbi J, Nordmann JP. [Boston Keratoprosthesis with temporal aponeurosis graft: A solution when there seems to be no more]. J Fr Ophtalmol 2018; 41:830-835. [PMID: 30343989 DOI: 10.1016/j.jfo.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To report cases of patients with severe bilateral corneal blindness and recurrent refractory perforation to keratoplasty and conventional treatment, for whom Boston keratoprosthesis (KP) was a satisfactory alternative when combined with a temporalis aponeurosis graft. DESCRIPTION OF CASES The first patient had progressive Lyell syndrome with spontaneous corneal perforation. The second had a severe graft vs. host reaction with a persistent Seidel-positive descemetocele. Despite repeated penetrating keratoplasties, amniotic membrane (AM) transplantations, and buccal mucosal (BM) grafts, they both experienced recurrent corneal perforation. The only solution thus appeared to be Boston Type I KP surgery. One month postoperatively, the first patient had to receive a temporalis aponeurosis (TA) graft, due to thinning of the recipient graft. Six months postoperatively, his visual acuity (VA) was 1/10 without correction, and the corneal status had been stabilized. The second patient underwent KP and TA graft concurrently. Six months after surgery, VA was 2/10 uncorrected, and the local inflammation had been stabilized. OBSERVATION Boston type I keratoprostheses constitute an alternative in cases of severe bilateral corneal blindness with perforation refractory to conventional treatment and surgery, with satisfactory visual results. DISCUSSION Patients with preoperative severe ocular surface disease are at greater risk of postoperative keratolysis. For our patients with a higher risk, TA graft prevented corneal melt. TA seems to be more effective than AM or BM in preventing corneal thinning or melt. CONCLUSION We would recommend performing a TA graft in combination with Boston KP surgery concurrently as first line treatment in eyes with severe ocular surface inflammation.
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Affiliation(s)
- L Moyal
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
| | - R Adam
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J Boumendil
- Service d'ophtalmologie IV, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J Meney
- Service d'ophtalmologie IV, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - T Rodallec
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J Akesbi
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J-P Nordmann
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
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Iyer G, Srinivasan B, Agarwal S, Pattanaik R, Rishi E, Rishi P, Shanmugasundaram S, Natarajan V. Keratoprostheses in silicone oil-filled eyes: long-term outcomes. Br J Ophthalmol 2018; 103:781-788. [PMID: 30021817 DOI: 10.1136/bjophthalmol-2018-312426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/22/2018] [Accepted: 06/24/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE To analyse the functional and anatomical outcomes of different types of keratoprostheses in eyes with retained silicone oil following vitreoretinal surgery. METHODS Retrospective chart review of patients operated with any type of permanent keratoprosthesis (Kpro) in silicone oil-filled eyes between March 2003 and June 2017 were analysed. RESULTS 40 silicone oil-filled eyes underwent keratoprostheses, of which 22 were type 1 and 18 were type 2 Kpros (Lucia variant-nine, modified osteo odonto kerato prosthesis (MOOKP)-four, Boston type 2-three and osteoKpro-two) with a mean follow-up of 61.54 , 42.77, 45.25 , 25 and 37 months, respectively. Anatomic retention of the primary Kpro was noted in 33 eyes (82.5%). A best-corrected visual acuity of better than 20/200 and 20/400 was achieved in 26 (65%)+32 (80%) eyes. Retroprosthetic membrane (RPM) was the most common complication noted in 17 eyes (42.5%). Perioptic graft melt was noted in 4 of 22 eyes of the type 1 Kpro (2 (10.5%) without associated ocular surface disorder (OSD)) and in 1 eye each of Boston and Lucia type 2 Kpro. Laminar resorption occurred in one eye each of the MOOKP and OKP groups. Endophthalmitis and glaucoma did not occur in any eye. CONCLUSION Appropriately chosen keratoprosthesis is a viable option for visual rehabilitation in eyes post vitreoretinal surgery with retained silicone oil-induced keratopathy not amenable to conventional penetrating keratoplasty. Kpro melt among type 1 Kpro did not occur in 89.5% eyes without associated OSD (19 of 22 eyes), despite the lack of aqueous humour and presence of RPM (4 eyes), two factors considered to play a significant role in the causation of sterile melts. Of interest to note was the absence of infection in any of these eyes. The possible protective role of oil from endophthalmitis is interesting, though yet to be ascertained.
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Affiliation(s)
- Geetha Iyer
- CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Bhaskar Srinivasan
- CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Shweta Agarwal
- CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ruchika Pattanaik
- CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Viswanathan Natarajan
- Department of Preventive Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Iyer G, Srinivasan B, Agarwal S, Talele D, Rishi E, Rishi P, Krishnamurthy S, Vijaya L, Subramanian N, Somasundaram S. Keratoprosthesis: Current global scenario and a broad Indian perspective. Indian J Ophthalmol 2018; 66:620-629. [PMID: 29676302 PMCID: PMC5939150 DOI: 10.4103/ijo.ijo_22_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Keratoprosthesis (Kpro) forms the last resort for bilateral end-stage corneal blindness. The Boston Type 1 and 2 Kpros, the modified osteo-odonto Kpro and the osteo-Kpro are the more frequently and commonly performed Kpros, and this review attempts to compile the current data available on these Kpros worldwide from large single-center studies and compare the indications and outcomes with Kpros in the Indian scenario. Although the indications have significantly expanded over the years and the complications have reduced with modifications in design and postoperative regimen, these are procedures that require an exclusive setup, and a commitment toward long-term follow-up and post-Kpro care. The last decade has seen a surge in the number of Kpro procedures performed worldwide as well as in India. There is a growing need in our country among ophthalmologists to be aware of the indications for Kpro to facilitate appropriate referral as well as of the procedure to enable basic evaluation during follow-ups in case the need arises, and among corneal specialists interested to pursue the field of Kpros in understanding the nuances of these surgeries and to make a judicious decision regarding patient and Kpro selection and more importantly deferral.
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Affiliation(s)
- Geetha Iyer
- CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Bhaskar Srinivasan
- CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Shweta Agarwal
- CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Deepti Talele
- CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sripriya Krishnamurthy
- Smt Jadhavbai Nathamal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Lingam Vijaya
- Smt Jadhavbai Nathamal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Shanmugasundaram Somasundaram
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Bharathi Salai, Ramapuram, Chennai, Tamil Nadu, India
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Outcomes of Boston keratoprosthesis type 1 reimplantation: multicentre study results. Can J Ophthalmol 2018; 53:284-290. [DOI: 10.1016/j.jcjo.2017.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 11/19/2022]
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Boston keratoprosthesis type 1: outcomes of the first 38 cases performed at Moorfields Eye Hospital. Eye (Lond) 2018; 32:1087-1092. [PMID: 29440740 DOI: 10.1038/s41433-018-0016-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/14/2017] [Accepted: 12/20/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate outcomes of Boston keratoprosthesis type 1 (K-Pro) surgery in a cohort of high-risk patients at Moorfields Eye Hospital. Our patients were referred to us at the end-point of their ocular disease. METHODS A retrospective review of all K-Pro surgery performed between March 2011 and July 2015 with a minimum follow-up of 12 months. RESULTS 39 eyes of 38 patients were included. Mean follow-up was 28.4 months (range: 12-56). The main indication for surgery was bullous keratopathy from multiple failed grafts (56%). 26 cases (72.2%) had known posterior segment disease pre-operatively. Mean BCVA for the entire cohort (n = 39) initially improved from HM vision to 1/60 before returning to CF vision by 6 months and was maintained for the duration of follow-up. By final follow-up (n = 39), 46% had improved vision (1 line improvement in 10%; 2 lines or more in 36%) and 31% maintained pre-operative visual acuity. Anterior segment pathology was not an independent variable in visual outcome. However, absence of posterior segment disease was significant and performed best, improving from HM to 6/15 and maintaining that vision in the longer term. There were 13 (33%) cases of progressive glaucomatous optic neuropathy, 10 (26%) retinal detachments, 8 (21%) retroprosthetic membranes, 3 (8%) infective keratitis and 2 (5%) vitritis of which 1 progressed to endophthalmitis. In all, 3 (8%) had NPL vision and 4 (10%) required removal of the K-Pro. CONCLUSIONS Implantation of the Boston K-Pro can lead to improved vision, with the main limiting factor being posterior segment pathology.
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Long-Term Visual Outcomes, Complications, and Retention of the Boston Type I Keratoprosthesis. Cornea 2017; 37:3-10. [DOI: 10.1097/ico.0000000000001405] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Muzychuk AK, Durr GM, Shine JJ, Robert MC, Harissi-Dagher M. No Light Perception Outcomes Following Boston Keratoprosthesis Type 1 Surgery. Am J Ophthalmol 2017; 181:46-54. [PMID: 28662941 DOI: 10.1016/j.ajo.2017.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the incidence rate, principal causes, and clinical course of eyes developing no light perception (NLP) visual acuity (VA) following Boston Keratoprosthesis (B-KPro) type 1 surgery. Secondary objectives include determining the incidence rate, relative risk (RR), and survival probability with respect to NLP outcomes among eyes with congenital aniridia. DESIGN Retrospective, interventional case series. SUBJECTS All patients undergoing B-KPro type 1 surgery between October 2008 and June 2016 by a single surgeon at CHUM - Hôpital Notre-Dame. METHODS Records of patients having undergone B-KPro implantation were reviewed. Eyes with a final outcome of NLP were further reviewed to determine best recorded postoperative VA, time to NLP onset, clinical course, and principal cause. Descriptive statistics, incidence rates, Kaplan-Meier survival curves, and the RR of NLP outcomes among eyes with aniridia were determined. Statistical significance was defined as P < .05. RESULTS Records of 119 patients were included, with an average follow-up of 49.1 ± 26.8 months postoperatively. Nineteen eyes had a final outcome of NLP, representing 16.0%. The incidence rate of NLP was 0.04 cases per eye-year of follow-up. The most common principal causes were inoperable retinal detachment (n = 7, 36.8%), terminal glaucoma (n = 6, 31.6%), and carrier graft melt-related complications (n = 5, 26.3%). The RR of developing NLP among eyes with aniridia was 3.04 (P = .01). CONCLUSIONS No light perception is a devastating but uncommon outcome of B-KPro surgery. Patients with aniridia seem to be at increased risk. In spite of all available medical and surgical interventions, some eyes may still suffer this outcome.
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Affiliation(s)
- Adam K Muzychuk
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada.
| | - Georges M Durr
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Julien J Shine
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Marie-Claude Robert
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
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Bouhout S, Robert MC, Deli S, Harissi-Dagher M. Corneal Melt after Boston Keratoprosthesis: Clinical Presentation, Management, Outcomes and Risk Factor Analysis. Ocul Immunol Inflamm 2017; 26:693-699. [PMID: 28080168 DOI: 10.1080/09273948.2016.1269930] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the presentation, risk factors, and outcomes of keratolysis after Boston type I keratoprosthesis (B-KPro). METHODS Retrospective chart review. RESULTS A total of 16 (14%) of the 110 eyes (96 patients) which underwent B-KPro implantation developed keratolysis at an average 20 ± 11 months. Retroprosthetic membrane (RPM), infectious keratitis, and corneal dellen were identified in 31%, 25%, and 13% of corneal melts, respectively. Five eyes had keratolysis without a readily identifiable cause. RPM (odds-ratio, OR = 4.4, p = 0.02) and infectious keratitis (OR = 17.6, p<0.0005) were confirmed as significant risk factors. Retinal detachment (p = 0.001) and choroidal detachment (p = 0.003) were more common in eyes with keratolysis. Management included B-KPro removal or exchange (n = 7), amniotic membrane transplantation (n = 1), tectonic corneal transplantation (n = 2), medical treatment (n = 4), and observation (n = 2). CONCLUSIONS The risk of keratolysis following B-Kpro increases with the development of RPM and infectious keratitis. Patients with keratolysis had higher complication rates and should receive rigorous monitoring.
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Affiliation(s)
- Soumaya Bouhout
- a Faculty of Medicine, McGill University , Montréal , Québec , Canada
| | - Marie-Claude Robert
- b Department of Ophthalmology , Centre Hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - Sousans Deli
- c Faculty of Medicine, Université de Montréal , Montréal , Québec , Canada
| | - Mona Harissi-Dagher
- b Department of Ophthalmology , Centre Hospitalier de l'Université de Montréal , Montréal , Québec , Canada
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