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ETIOLOGY OF KERATOPROSTHESIS LOSS: RESULTS FROM THE BOSTON
KERATOPROSTHESIS MULTICENTER STUDY
J.B. Ciolino, MD; J.D. Ament, MD; B.L. Zerbe, MD; M. W. Belin, MD
Albany Medical College & Massachusetts Ear and Eye Infirmary, Harvard Medical School
INTRODUCTON
Over the last 200 years, several groups have worked to develop a keratoprosthesis
(Kpro) to treat patients with corneal blindness and a poor prognosis for penetrating
keratoplasty (PK). These include patients with repeated graft failures, chemical
injury, and autoimmune diseases. There are several K-pro designs that have been
developed throughout the world. The most commonly used design in the United
States is the Boston (Type 1) K-Pro. In 1974, Claes Dohlman first reported results
from the implantation of a polymethyl methacrylate (PMMA) collar-button K-pro in
36 patients. In 1993, the Boston Type 1 K-Pro was approved by the FDA for
marketing in the United States. The Boston Keratoprosthesis is typically used after
multiple failed cornea transplants. The Boston K-Pro has also offered hope to
patients with severe ocular surface disease resulting from chemical injuries and
cicatricial autoimmune diseases.
RESULTS
months
Figure 1.
Figure 2.
Survival of traditional cornea
re-graphs and subsequent regraft, Ref 2.
Survival of Boston KPro stratified by
preoperative diagnosis
PURPOSE
21 of 252 implanted keratoprosthesis were not retained during the study
period. Overall the retention rate was 91.6% (average follow-up of 13
months, range 1 – 53 months). Figures 1 and 2 demonstrate repeat
corneal transplant survival and that of the Boston KPro survival.
25.6% (11/ 43) of patients with autoimmune disease failed to retain the
KPro. 9 of the autoimmune KPro’s lost developed a cornea melt around
the implant requiring its replacement.
10.7% (3/ 28) KPro’s in the chemical injury group required replacement.
2 due to thinning of the peripheral donor cornea at the donor-host
interface.
Only 3.8% (7/ 181) of the remaining KPro’s were not retained. 3 of the
eyes were enucleated after large retinal detachments, 2 were replaced
due to fungal keratitis, and 2 experienced a corneal melt around the
implant.
CONCLUSION
To report causes of failure to retain the Boston Type 1 Keratoprosthesis.
Patients with autoimmune disease have the poorest KPro retention
mostly due to cornea melting around the implant. Patients with chemical
injuries also have a guarded prognosis and appear to be at a higher risk
of thinning of the peripheral donor cornea. Patients lacking chemical
injury or autoimmune disease have an excellent retention rate (96%).
METHODS
Prospective, non-comparative, interventional case series from the Boston Type 1
Keratoprosthesis Study Group over a 4 year period was collected. Pre-operative
and post-operative data was analyzed from the 22-surgeon multicenter study
group.
Participating Surgeons:
Juan-Carlos Abad, M.D.
Anthony J. Aldave, M.D.
James Aquavella, M.D.
Michael W. Belin, M.D.
Kathryn Colby, M.D.
Puwat Charukamnoetkanok, M.D.
Elizabeth Hofmeister, M.D.
Ramzi K. Hemady, M.D.
Mark J. Mannis, M.D.
Roberto Pineda II, M.D.
Kimberly C. Sippel, M.D.
Natalie A. Afshari, M.D.
Eduardo C. Alfonso, M.D.
Keith H. Baratz, M.D.
Prabjot Channa, M.D.
John W. Cowden, M.D.
Claes H. Dohlman, M.D.
Sadeer B. Hannush, M.D.
Marian S. Macsai, M.D.
Samir A. Melki, M.D.
Tueng T. Shen, M.D,
Geoffrey Tabin, M.D
Figure 3.
Figure 4.
Boston KPro PMMA back plate
Boston KPro Titanium back plate
REFERENCES
700
600
Outside
Surgeons
MEEI
500
Figure 5.
Boston KPro
use by year
400
300
200
100
0
1.
Zerbe BL, Belin MW, Ciolino JB. Boston Type 1 Keratoprosthesis
Study Group. Ophthalmology. 2006 Oct;113(10):1779.
2.
Bersudsky V, Blum-Hareuveni T, Hehany U, Rumelt S. The Profile of
Repeated Corneal Transplantation. Ophthalmology 2001:108:461469.
The authors have no financial interest in the study material.
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