Boston keratoprosthesis in epithelial downgrowth

Area of Science:

• Ophthalmology
• Corneal Surgery
• Ocular Prosthetics

Background:

• Epithelial downgrowth is a severe complication following intraocular surgeries.
• Multiple failed penetrating keratoplasties and glaucoma surgeries present a significant challenge.
• Congenital ocular syphilis with secondary glaucoma can lead to complex corneal pathology.

Purpose of the Study:

• To report a case of successful long-term treatment of epithelial downgrowth.
• To evaluate the efficacy of Boston keratoprosthesis implantation in a complex ocular case.
• To present a novel therapeutic option for recalcitrant epithelial downgrowth.

Main Methods:

• A 61-year-old monocular patient with a history of epithelial downgrowth and multiple failed corneal grafts underwent Boston keratoprosthesis implantation.
• The procedure was combined with anterior vitrectomy.
• Outcomes measured included visual acuity, ocular inflammation, and media clarity.

Main Results:

• Restored media clarity revealed underlying retinal scarring and optic nerve pallor.
• Best corrected visual acuity of 20/400 was achieved and maintained for 6 years.
• No recurrence of epithelial downgrowth or retroprosthesis membrane formation was observed.

Conclusions:

• Boston keratoprosthesis implantation represents a viable, long-term treatment for epithelial downgrowth.
• This case is the first reported instance of successful long-term management of epithelial downgrowth using a Boston keratoprosthesis.
• This approach may be considered for complex cases of epithelial downgrowth refractory to other treatments.