Related Experiment Video
Updated: Nov 7, 2025
Full-Field Optical Coherence Microscopy for Histology-Like Analysis of Stromal Features in Corneal Grafts
Published on: October 21, 2022
Short-Term Outcomes of Pediatric Keratoprosthesis With the Near-Complete Conjunctival Flap
Mohammad H Bawany1, Callais Kudla2, Faraaz A Khan2
1University of Rochester, School of Medicine and Dentistry, Rochester, NY.
Insights
Adding a conjunctival flap during Boston keratoprosthesis (KPro) surgery in pediatric patients significantly reduced complications and improved visual acuity within one year. This technique shows promise for better outcomes in children with congenital corneal opacities.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Congenital corneal opacities pose challenges for pediatric vision.
- The Boston keratoprosthesis (KPro) is used for vision restoration in such cases.
- Optimizing KPro outcomes in children is crucial for long-term visual health.
Purpose of the Study:
- To evaluate the impact of a near-complete conjunctival flap on Boston type 1 KPro outcomes in pediatric patients.
- To compare complication rates and visual acuity between KPro with and without a conjunctival flap.
Main Methods:
- Retrospective chart review of 21 pediatric eyes undergoing first KPro implantation.
- Comparison of outcomes between eyes with and without a conjunctival flap, incorporating data from 2011-2017.
- Analysis of surgical complications (e.g., corneal melt, endophthalmitis) and visual acuity up to 1-year postoperatively.
Main Results:
- Eyes with a conjunctival flap experienced fewer KPro-related surgical complications (5 vs. 16, P=0.0002).
- Corneal melt occurred in 18% of the flap group versus 50% in the non-flap group (P=0.12).
- Visual acuity improved by 1 year in 82% of the flap group compared to 50% in the non-flap group (P=0.3).
Conclusions:
- Implementing a conjunctival flap during pediatric KPro surgery may reduce short-term complications requiring intervention.
- This technique shows potential for improving visual acuity in pediatric patients post-KPro implantation.
- Further research with longer follow-up is necessary to fully ascertain the benefits of conjunctival flaps in pediatric KPro outcomes.
Purpose:
The Boston keratoprosthesis (KPro) has been used for certain indications in pediatric patients with congenital corneal opacities. Here, we describe the use of a near-complete conjunctival flap at the time of Boston type 1 KPro surgery in pediatric patients, with the goal of improving pediatric KPro outcomes.
Methods:
We performed a retrospective chart review of 21 eyes from 16 patients who received their first KPro before the age of 18 years at a tertiary care center in Rochester, NY. Surgeries were performed between 2011 and 2017 (3 years before and after the incorporation of a conjunctival flap, which began in 2014 as part of the pediatric KPro procedure). Patients who had a minimum 1-year postoperative follow-up, or had corneal melts within 1 year of KPro implantation, were included in our study. The main outcome measure in this study was a comparison of the number of complications that required surgical intervention, including retroprosthetic membrane, corneal melt, retinal detachment, and endophthalmitis, in eyes that received KPro implantation without a conjunctival flap compared with eyes that received KPro implantation with a conjunctival flap. Change in the visual acuity up to 1 year postoperatively was also measured.
Results:
Ten eyes received KPro with no conjunctival flap, and 11 eyes received KPro with a near-complete conjunctival flap. After 1-year postoperative follow-up, eyes receiving a KPro with a conjunctival flap had fewer KPro-related complications requiring surgical intervention (5 vs. 16, P = 0.0002). Corneal melt was seen in 2 of 11 (18%) eyes in the conjunctival flap group and 5 of 10 (50%) eyes in the nonflap group (P = 0.12). No eyes developed endophthalmitis in the flap group, whereas 1 of 10 (10%) eyes developed endophthalmitis in the nonflap group. Visual acuity at 1-year follow-up improved in 9 of 11 (82%) eyes in the flap group compared with 5 of 10 (50%) eyes in the nonflap group (P = 0.3).
Conclusions:
Implementation of a conjunctival flap in pediatric KPro may help decrease the short-term postoperative complications requiring surgical procedures and may lead to improved visual acuity after 1 year. Further investigation, including longer-term follow-up, is needed to better understand how the described technique affects surgical outcomes in children.
