[Results with the Boston keratoprosthesis]

The Boston keratoprosthesis (BKP) is a surgical therapeutic option in patients with corneal disease and poor prognosis for penetrating keratoplasty. The purpose of this study was to summarize our results with this surgical technique which we have employed at our institution since November 2009.

All patients who underwent the BKP procedure at our institution between November 2009 and August 2011 were identified retrospectively and the data were analyzed. The surgical procedure and postoperative treatment were performed following the recommendations of the developers of the BKP.

A total of 14 patients were included in the study and the patient age ranged from 36 to 78 years. All patients had superficial and stromal corneal opacification with loss of the normal corneal surface (conjunctivalization). In 13 patients the BKP was implanted after at least 1 penetrating keratoplasty (including 3 matched grafts) and in 1 patient it was performed as a primary procedure. The underlying diseases were Stevens-Johnson syndrome, chemical injury, chronic atopic dermatitis in neurodermitis, keratoconus, granulomatous uveitis, congenital glaucoma and eyeball injury/burn. The follow-up ranged from 1 to 21 months. Postoperative complications consisted of prolonged inflammatory anterior chamber reaction with synechia, deposits on the intraocular lens, posterior capsule opacification, secondary glaucoma, hypotension, conjunctival growth over the keratoprosthesis and cystoid macular edema. All cases had overall improvement of visual acuity at the last follow-up visit. The maximum improvement was from counting fingers to 0.7.

Until now all BKPs have been preserved. At our institution the BKP is becoming increasingly more important even in such cases with a (very) poor prognosis for matched limbal and/or corneal grafts. Reimbursement for the BKP must, however be organized on a case by case basis.