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A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study
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Type 1 Boston keratoprosthesis: outcomes at two Canadian centres.

Christopher W Noel1, Jordan Isenberg1, Yakov Goldich1

  • 1Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Ont.

Canadian Journal of Ophthalmology. Journal Canadien D'Ophtalmologie
|April 18, 2016
PubMed
Summary

Boston type 1 keratoprosthesis (Kpro) surgery significantly improves visual acuity (VA) in patients with severe corneal disease. This artificial cornea offers a viable alternative when traditional corneal transplants have a poor prognosis, achieving high retention rates.

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Prosthetic Devices

Background:

  • Corneal transplantation is the standard treatment for severe corneal disease.
  • However, some patients have a poor prognosis with traditional penetrating keratoplasty due to factors like multiple graft failures or severe ocular surface disease.

Purpose of the Study:

  • To evaluate the outcomes of Boston type 1 keratoprosthesis (Kpro) surgery.
  • To assess visual acuity, retention rates, and complications in patients undergoing Kpro.

Main Methods:

  • A retrospective case series of 44 eyes from 43 patients who underwent Kpro surgery between June 2008 and July 2013.
  • Analysis of preoperative characteristics and postoperative outcomes, including visual acuity and complications.

Main Results:

  • The primary indication for Kpro was failed corneal transplantation (70%).
  • Preoperative visual acuity was poor (≥20/150), with 89% having counting fingers or worse.
  • The Kpro retention rate was 95% at a mean follow-up of 21 months.
  • Best-achieved median visual acuity was 20/100, with 37% achieving >20/40 postoperatively.
  • Common complications included retroprosthetic membrane (52%) and elevated intraocular pressure (23%).

Conclusions:

  • Boston type 1 keratoprosthesis surgery significantly improves visual acuity in a majority of patients.
  • Kpro is a viable treatment option for eyes with a poor prognosis for conventional corneal transplantation.