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Clinical features and prognosis of Boston type I keratoprosthesis-associated corneal melt
Canan Asli Utine1, Jonathan H Tzu, Esen K Akpek
1Ocular Surface Disease and Dry Eye Clinic, Cornea and External Disease Service, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-9238, USA.
Purpose:
To describe the clinical features and outcomes of corneal melt associated with Boston type I keratoprosthesis (KPro) implantation.
Methods:
Medical records of patients who experienced corneal melt following KPro implantation were reviewed retrospectively.
Results:
Sixty-six adult patients had KPro implantation from January 2004 to November 2010. Six patients had an underlying inflammatory ocular surface disorder. Four experienced corneal melt (6.1%) 5-42 months after the initial surgery. One patient was diagnosed with Sjögren's syndrome as a result of diagnostic workup following melt. Three patients were treated with systemic immunomodulatory therapy; two experienced fungal keratitis and subsequent endophthalmitis. KPro had to be explanted and replaced with donor cornea in all cases.
Conclusions:
KPro-associated corneal melt is uncommon and appears to occur in patients with preexisting inflammatory disorders, which might not have been previously diagnosed. Timely explantation of KPro and replacement with donor cornea may prevent a poor outcome.
