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The Risk of Retinal Detachment Following Boston Keratoprosthesis Type 1 Implantation: Insights From a Retrospective
Simon Elsliger1, Maya Sebag2, Wissam B Nassrallah1
1From the Department of Ophthalmology (S.E., W.B.N., M.B., A.B., D.G., A.A.E., M.H.D.), Université de Montréal, Montréal, Québec, Canada.
Purpose:
To evaluate the incidence, risk factors, management strategies, and visual outcomes of retinal detachment (RD) following Boston Keratoprosthesis Type 1 (KPro) implantation.
Design:
Single-center, retrospective observational case series.
Methods:
Medical records of 157 eyes from 122 adult patients who underwent Boston Type 1 KPro implantation at a tertiary care center between 2008 and 2022 were reviewed. Inclusion criteria included age ≥18 years and postoperative follow-up of at least 1 year. Demographic data, preoperative characteristics, postoperative complications, and visual outcomes were collected. Univariate and multivariate statistical analyses were conducted to identify significant risk factors for RD. Cox regression and Kaplan-Meier survival analysis were used to evaluate time-to-event data.
Results:
Of the 157 eyes that underwent Boston Type 1 KPro implantation, 27 eyes (17.2%) developed retinal detachment (RD), all within 8 years postoperatively (2 RD per 100 eye years). Aniridia was significantly associated with increased RD risk (OR: 2.79; 95% CI: 1.23-6.70), while other preoperative diagnoses were not. Eyes with RD were more likely to experience hypotony (OR: 7.63; P < .0001), choroidal detachment (OR: 7.67; P < .0001), phthisis (OR: 7.69; P < .0001), and other serious complications. Surgical intervention was possible in 16 of the 27 RD cases, with pneumatic retinopexy being the most common approach.
Conclusions:
Retinal detachment is a significant complication following KPro implantation, particularly in patients with aniridia. Postoperative hypotony and other inflammatory complications may contribute to increased RD risk and challenge surgical repair. Close monitoring of high-risk patients may help mitigate long-term visual morbidity.
