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A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study
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Experience with Boston keratoprosthesis type 1 in the developing world.

Lauro Augusto de Oliveira1, Fernanda Pedreira Magalhães1, Flavio E Hirai1

  • 1Federal University of São Paulo, UNIFESP, Brasil.

Canadian Journal of Ophthalmology. Journal Canadien D'Ophtalmologie
|August 9, 2014
PubMed
Summary

Boston type 1 keratoprosthesis surgery is a viable option for treating complex eye conditions in developing countries. This study shows significant visual acuity improvements and good prosthesis retention, comparable to developed nations.

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Prosthetic Implantation

Background:

  • Corneal transplantation is often unsuccessful in patients with severe corneal damage, chemical injuries, or Stevens-Johnson syndrome.
  • Boston type 1 keratoprosthesis offers a potential solution for visual rehabilitation in cases of multiple graft failures or poor keratoplasty prognosis.
  • Limited data exists on the efficacy and safety of Boston type 1 keratoprosthesis in developing countries.

Purpose of the Study:

  • To evaluate the outcomes of Boston type 1 keratoprosthesis implantation in a developing world setting.
  • To assess visual acuity, prosthesis stability, and postoperative complications in patients undergoing this procedure.

Main Methods:

  • A prospective interventional study involving 30 patients (30 eyes) who received Boston type 1 keratoprosthesis between 2008 and 2012.
  • Analysis of preoperative diagnoses including failed grafts, chemical injuries, and Stevens-Johnson syndrome.
  • Assessment of visual acuity, keratoprosthesis retention, and complications including glaucoma, infectious keratitis, and retinal detachment.

Main Results:

  • Significant improvement in best corrected visual acuity (BCVA) to >20/200 in 80% of patients post-surgery.
  • High keratoprosthesis retention rate of 93.3% over an average follow-up of 32 months.
  • Common complications included retroprosthetic membrane (26.66%) and glaucoma progression or development (43% of eyes with preoperative glaucoma).

Conclusions:

  • Boston type 1 keratoprosthesis implantation is a feasible and effective treatment option for severe corneal conditions in developing countries, yielding results comparable to developed nations.
  • The procedure is particularly beneficial for patients with multiple failed keratoplasties or poor prognoses for conventional corneal transplantation.
  • Careful consideration of postoperative management, especially regarding glaucoma, is crucial for optimizing outcomes in this setting.