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Keratoprosthesis: procedure of choice for corneal opacities in children?
Sudha Nallasamy1, Kathryn Colby
1Department of Ophthalmology, Children's Hospital Boston, MA, USA.
Insights
Boston keratoprosthesis offers a viable alternative to pediatric keratoplasty, providing clear vision and stable outcomes. Long-term care is essential for success in children with amblyogenic potential.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Corneal Surgery
Background:
- Pediatric corneal transplantation (keratoplasty) faces significant challenges, including graft clarity issues, suboptimal visual acuity, and high rejection rates.
- Keratoprosthesis offers a potential solution for complex pediatric corneal diseases.
Observation:
- The Boston type I keratoprosthesis demonstrates rapid achievement of a clear visual axis and stable refractive error.
- Unlike allografts, keratoprosthesis eliminates the risk of immune rejection.
Findings:
- Penetrating keratoplasty in children has poor graft survival (44% at 50 months) and visual outcomes (30-34% achieving 20/400).
- High rates of allograft rejection (40-50%) complicate pediatric keratoplasty.
- Boston keratoprosthesis requires lifelong management, including topical medications, bandage contact lenses, and interventions for complications like retroprosthetic membranes and glaucoma.
Implications:
- The Boston keratoprosthesis can lead to successful anatomical and functional outcomes in pediatric patients of amblyogenic age, provided parental commitment.
- Careful patient selection and long-term follow-up are crucial for optimizing results with pediatric keratoprosthesis.
Purpose:
The purpose of this study is to review the current literature on keratoprosthesis and its use in the pediatric population.
Methods:
Case report and review of recent literature on outcomes of pediatric keratoplasty and keratoprosthesis.
Results:
Penetrating keratoplasty in children is fraught with shortcomings, including difficulty maintaining a clear graft (as low as 44% at 50 months), poor visual acuity outcomes (only 30-34% achieving 20/400 or better), and a high rate of allograft rejection (40-50%). Placement of the Boston type I keratoprosthesis has the advantage of achieving a clear visual axis and stable refractive error within days of surgery without risk of rejection. However, life-long care is required, including topical steroids and antibiotic prophylaxis, as well as bandage contact lens wear and a frequent a need for further interventions for retroprosthetic membranes and glaucoma.
Conclusions:
With motivated parents, a successful anatomic and functional outcome can be achieved with the Boston keratoprosthesis in children of amblyogenic age.
