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Recurrent retroprosthetic membranes in Boston Keratoprosthesis Type I: Incidence, risk factors, and complications
Katherine G Chen1, Taylor W Starnes1, Sasha Kravets2
1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
Purpose:
To identify pre-operative surgical factors associated with recurrent retroprosthetic membranes (RPMs) after Boston Keratoprosthesis (KPro) implantation, and to compare outcomes of patients with recurrent RPMs to those who had single or no RPM formation.
Methods:
A single-center, retrospective study of all patients who underwent Boston Type I KPro implantation between 2006 and 2017 was performed. Patients with less than 1 year follow-up after device implantation were excluded. Patients were divided into 3 groups - no RPM, single RPM, and recurrent RPM. Recurrent RPM was defined as ≥2 visually significant RPM during follow-up. Statistical analysis was performed to assess factors associated with RPM status. Primary outcome measures included best-corrected visual acuity at 1 year and the need for RPM-related surgeries.
Results:
109 of 148 KPro patients met the inclusion criteria. 45 % of patients had no RPM, 36.7 % had a single RPM, and 18.3 % had recurrent RPMs. At 1-year follow-up, visual acuity was decreased in both the recurrent (LogMAR 1.6) and single RPM (LogMar 1.18) groups compared to eyes with no RPM (LogMar 0.94). Eyes with recurrent RPM also required a significantly higher proportion of RPM-related surgery (p < 0.001). Eyes without prior penetrating keratoplasty (p = 0.04), pre-operative aniridia (p = 0.01), and post-operative occurrence of retinal detachments (p < 0.001) and corneal melts (p < 0.001) were found to be statistically significantly associated with RPM status.
Conclusions:
Retroprosthetic membranes, especially when recurrent, play an important role in the secondary complications, visual outcomes, and device retention after KPro implantation.
Insights
Recurrent retroprosthetic membranes (RPMs) after Boston Keratoprosthesis (KPro) implantation negatively impact visual acuity and increase the need for surgery. Factors like prior keratoplasty and aniridia are associated with RPM development.
Area of Science:
- Ophthalmology
- Biomedical Engineering
- Corneal Surgery
Background:
- Boston Keratoprosthesis (KPro) implantation is a sight-restoring procedure for severe corneal blindness.
- Retroprosthetic membranes (RPMs) are a known complication, potentially impairing visual outcomes.
- Understanding factors associated with recurrent RPMs is crucial for improving KPro success rates.
Purpose of the Study:
- To identify pre-operative surgical factors linked to recurrent retroprosthetic membranes (RPMs) following Boston Type I Keratoprosthesis (KPro) implantation.
- To compare the visual outcomes and surgical needs of patients with recurrent RPMs versus those with single or no RPMs.
Main Methods:
- Retrospective analysis of patients undergoing Boston Type I KPro implantation between 2006-2017.
- Exclusion of patients with less than one year of follow-up.
- Categorization into three groups: no RPM, single RPM, and recurrent RPM (≥2 visually significant RPMs).
Main Results:
- 109 patients met inclusion criteria; 18.3% experienced recurrent RPMs.
- Recurrent RPMs were associated with significantly worse 1-year visual acuity (LogMAR 1.6) and higher rates of RPM-related surgery.
- Pre-operative factors associated with RPM status included prior penetrating keratoplasty, pre-operative aniridia, post-operative retinal detachment, and corneal melts.
Conclusions:
- Recurrent retroprosthetic membranes significantly compromise visual outcomes and device retention after KPro surgery.
- Identifying and managing pre-operative risk factors may help mitigate RPM formation.
- Further research into preventative strategies for RPMs in KPro patients is warranted.
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