Adnexal surgeries in eyes with keratoprosthesis: challenges and long-term outcomes

To analyze the need for adnexal surgeries in eyes implanted with Keratoprosthesis (KPro) and their long-term outcomes.

Retrospective analysis of 39 eyes implanted with KPro that underwent oculoplastic procedures following or before the KPro surgery from 2016 to 2024. Analyzed data included the indications, outcomes, KPro survival, and changes in visual acuity.

Thirty-nine eyes (26 males) underwent oculoplastic procedures before or after type 1 KPro. KPro indications were Stevens-Johnson syndrome (n = 12), chemical injury (n = 20), chronic cicatrizing conjunctivitis (n = 3), corneal decompensation (n = 1), and trauma (n = 3). Oculoplastic indications were cicatricial entropion (n = 14), ectropion (n = 6), chronic dacryocystitis (n = 7), lagophthalmos (n = 12), trichiasis (n = 3), ptosis (n = 1), and endophthalmitis (n = 3). At a median of 27.9 months (IQR: 14.8-54.4) follow-up, KPro survived in 45% of eyes, and the oculoplastic procedure success rate was 94.9% after six repeat surgeries. Median BCVA improvement by 2 LogMAR (2.5-0.5) was noted in eyes where KPro survived. KPro survival rates are similar in eyes with chemical injuries or SJS. However, SJS eyes have more lacrimal drainage obstructions. KPro survival (62% vs. 53.3%) is better in eyes where adnexal surgeries are performed before than after the KPro implantation.

Various oculoplastic procedures are necessary for eyes with KPro, with cicatricial entropion and chronic dacryocystitis being the most common. The adnexal surgery success rate is good, and the KPro survival rate in such eyes is reasonable. Ocular surface and oculoplastic specialists should work closely together to enhance outcomes in these complex cases by conducting adnexal surgeries before KPro implantation.