Clinical Outcomes of Pars Plana Vitrectomy in Boston Keratoprosthesis Type I in Pediatric Patients

Keratoprosthesis offers certain pediatric patients with congenital corneal opacity an alternative for improving vision. Pars plana vitrectomy (PPV) combined with Boston keratoprosthesis type 1 (KPro) has demonstrated success in reducing postoperative complications such as retinal detachment (RD) in adults. However, its role and outcomes have yet to be investigated in pediatric patients. This study investigates the outcomes of PPV in KPro pediatric patients, with a focus on prosthesis retention, visual acuity (VA), and postoperative complications.

We performed a retrospective review of all pediatric patients who underwent PPV with KPro at a tertiary care center in Rochester, NY. Surgeries were performed between 2011 and 2016. Postoperative complications measured included RD, retroprosthetic membrane, and corneal melt. Additional outcomes included prosthesis retention, VA, and time to complications.

A combined KPro and PPV procedure was performed in 18 eyes from 15 pediatric patients, with follow-up ranging from 6 months to 10 years (median: 3.92 years). The overall KPro retention rate was 67%. Preoperative VA ranged from light perception to fix and follow, and among eyes with preoperative and postoperative VA data (11), six eyes (54.5%) improved, three (27.3%) remained the same, and two (18.2%) declined. RD occurred in eight of 18 eyes, retroprosthetic membrane developed in 11 of 18 eyes, and corneal melt occurred in 15 of 18 eyes.

Our findings suggest that PPV may improve pediatric KPro outcomes, providing valuable insights into restoring functional vision in children with congenital corneal opacity.