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[Retroprosthetic membrane formation in Boston keratoprosthesis type 1: Incidence, predisposing factors,
1Faculté de médecine, Université de Montréal, Montréal, Canada.
Objective:
Evaluate the incidence and risk factors for retroprosthetic membrane (RPM) formation after Boston keratoprosthesis type 1 (BKpro), identify the associated complications and describe the treatments offered.
Methods:
Retrospective cohort study. In total, 133 eyes of 115 patients who underwent BKpro at Centre Hospitalier de l'Université de Montréal (CHUM) from 2008 to 2017, with a minimum follow-up of 1 year, were included in the study. Records were examined, and data was collected, including RPM incidence, preoperative and intraoperative risk factors, postoperative complications and treatments offered.
Results:
Mean follow-up was 5.5 years. Thirty-nine percent (n=52) eyes developed RPM. No particular etiology was significatively associated with RPM formation. Simultaneous lensectomy or IOL extraction were respectively positively and negatively correlated with RPM formation. As for postoperative complications, the strongest correlation was found between RPM formation and retinal detachment. RPM formation was also positively associated with hypotony and corneal melt. Nd:YAG membranotomy was the most frequently used treatment, in 83 % of eyes with RPM (n=24), with resolution in 58 %.
Conclusion:
Over one third of BKpro patients will develop a RPM, thus requiring monitoring for associated retinal detachment. IOL extraction appears to be protective, whereas lensectomy appears to increase RPM formation. Nd:YAG membranectomy is used as an initial, non-invasive approach.
Insights
Over one-third of Boston keratoprosthesis type 1 (BKpro) recipients develop retroprosthetic membranes (RPMs). Monitoring for retinal detachment is crucial, as IOL extraction may be protective, while lensectomy increases RPM formation risk.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Regenerative Medicine
Context:
- Boston keratoprosthesis type 1 (BKpro) is a vital treatment for corneal blindness.
- Retroprosthetic membrane (RPM) formation is a significant complication impacting visual outcomes.
- Understanding RPM development is crucial for improving BKpro efficacy.
Purpose:
- To evaluate the incidence and risk factors of RPM formation after BKpro.
- To identify complications associated with RPMs.
- To describe treatment options for RPMs.
Summary:
- A retrospective study of 133 eyes (115 patients) undergoing BKpro revealed a 39% incidence of RPM formation.
- Simultaneous lensectomy correlated with increased RPMs, while IOL extraction showed a protective effect.
- Retinal detachment, hypotony, and corneal melt were significant complications; Nd:YAG membranotomy offered a 58% resolution rate.
Impact:
- Findings highlight the need for vigilant monitoring of BKpro patients for RPMs and associated complications like retinal detachment.
- The study suggests modifying surgical techniques, such as favoring IOL extraction over lensectomy, to potentially reduce RPM incidence.
- Nd:YAG membranotomy is confirmed as an effective initial treatment for RPMs.
