Transcript 960: Long-term Outcomes of the Boston Type 1 Keratoprosthesis

UC Davis
Long-Term Outcomes
of the Boston Type I
Keratoprosthesis
Jennifer Li, M.D., Mark Greiner, M.D.
Ana Carolina Vieira, M.D.
Mark Mannis, M.D.
University of California, Davis
Sacramento, California
The authors have no financial interest in the subject matter of this poster.
UC Davis
Study Purpose
• To evaluate long-term outcomes
after placement of Boston type 1
keratoprosthesis
• To determine the types and
frequency of complications that
may develop postoperatively
Materials and Methods
UC Davis
• A retrospective chart review of all
Boston type 1 keratoprosthesis
surgeries performed at a single
institution (UC Davis) beginning in
May, 2004 through January, 2010
UC Davis
Boston Keratoprosthesis
UC Davis, 2004-2010
Demographics
Number of eyes
40
Number of patients
35
Average age
Gender
Average follow-up time
52.9 years
(range 2-86 years)
57% M
43% F
30.1 months
Patient Demographics
UC Davis
Preoperative Corneal Diagnosis
# Eyes (%)
Avg. #
Prior
PKPs
Chemical burn
10 (25.0%)
1.6
Failed graft NOS
7 (17.5%)
2.3
Aniridia
5 (12.5%)
1.6
Keratoconus
4 (10.0%)
3.0
HSV
4 (10.0%)
2.5
Congenital hereditary endothelial
dystrophy
2 (5.0%)
1.0
8 (20.0%)
2.3
40 (100%)
2.0
Other
Thermal burn, Apert’s syndrome, ocular cicatricial
pemphigoid, Peters, Stevens-Johnson, rheumatoid
arthritis, Fuchs endothelial dystrophy, HLA-B27
uveitis
Total
Preoperative BCVA
12
Number of Patients
UC Davis
14
10
8
6
4
2
0
LP
HM
CF
20/400
20/200
20/150
F&F
(Fixates
&
Follows)
UC Davis
Preoperative Glaucoma
Preoperative Glaucoma
Number of eyes with
glaucoma (%)
23 (57.5%)
Average number of preop
glaucoma medications
1.52
Number of eyes with prior
glaucoma surgery (%)
14 (35%)
Preoperative versus
Postoperative BCVA
14
Postoperative
12
Number of Patients
UC Davis
16
Preoperative
10
8
6
4
2
0
>20/50 20/50- 20/150- 20/400
20/100 20/200
CF
HM
LP
NLP
Postoperative BCVA Changes:
Comparing pre-op to final post-op BCVA
Percentage of Eyes (N=40)
UC Davis
50%
40%
30%
20%
10%
0%
Improved ≥ 3 Lines
Unchanged +/- 3 Lines
Worsened ≥ 3 Lines or
NLP
Postoperative Complications
Complications of K-Pro
UC Davis
Retroprosthetic membrane
# Eyes (%)
22 (55.0%)
YAG laser membranectomy
10 (25.0%)
Surgical membranectomy
5 (12.5%)
Endophthalmitis
Glaucoma
5 (12.5%)
31 (77.5%)*
Progression
11 (27.5%)
GDD placement (excluding concomitant
GDDs)
1 (2.5%)
8 (20.0%)**
GDD erosion
Transscleral cyclophotocoagulation
2 (5.0%)
Endocyclophotocoagulation
3 (7.5%)
End-stage glaucoma
7 (17.5%)
Corneal melt with K-Pro extrusion
6 (15.0%)
Replacement of K-Pro
7 (17.5%)
Removal of K-Pro
3 (7.5%)
*23 (57.5%) had preoperative glaucoma diagnosis.
**7 of 8 GDD erosions required revision and/or removal of device.
UC Davis
Retroprosthetic Membrane
Extrusion of Keratoprosthesis
Periprosthetic Infiltrate
Exposed Tube Shunt
Conclusions
•
High percentage of patients have long-term BCVA equal to or
better than pre-operative visual acuity
UC Davis
•
There is a moderately high percentage of patients with long-term
complications status post Boston type 1 keratoprosthesis
placement
•
Progression of glaucoma and complications related to glaucoma
can be visually devastating
•
Although many patients may benefit from keratoprosthesis
placement, long-term visual prognosis is guarded.
•
Successful management of these patients requires pre- and
post-operative collaboration with glaucoma and vitreoretinal
specialists
•
Further study is needed to determine the best means of
managing postoperative glaucoma