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Long-term visual acuity, retention and complications observed with the type-I and type-II Boston keratoprostheses in an Irish population
  1. E S Duignan1,
  2. S Ní Dhubhghaill1,2,
  3. C Malone1,
  4. W Power1
  1. 1Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
  2. 2Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
  1. Correspondence to Dr Emma S Duignan, Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland; emmaduignan{at}rcsi.ie

Abstract

Aim To evaluate the outcomes of the type-I and type-II Boston keratoprostheses in a single Irish centre.

Methods A retrospective chart review of keratoprosthesis implantations carried out in our institution from November 2002 to March 2014 was performed. All procedures were performed by a single surgeon (WP).

Results Thirty-four keratoprosthesis implantations were carried out in 31 patients with a mean follow-up of 42±31 months (range 2–110 months). Seventeen patients were female (54.8%) and 14 were male (45.2%). The majority of keratoprostheses implanted were type-I (31/34, 91.2%), and three were type-II (3/34, 8.8%). Twenty-nine patients (85.3%) had an improvement in distance best-corrected visual acuity (BCVA) from baseline. Fifty per cent (17/34) of patients had a best-ever BCVA of at least 6/12. Eighteen patients (64.3%) retained a BCVA of at least 6/60 at 1 year. Over the course of follow-up, six keratoprostheses were explanted from six eyes of five patients, one of which was a type-II keratoprosthesis. Twenty-six patients (76.5%) developed postoperative complications. Complications included retroprosthetic membrane (18 patients, 52.9%), an exacerbation or new diagnosis of glaucoma (6 patients, 17.6%), endophthalmitis (5 patients, 14.7%) and retinal detachment (2 patients, 5.9%).

Conclusions These data demonstrate excellent visual acuity and retention outcomes in a cohort with a long follow-up period in a single centre. Complications remain a considerable source of morbidity. These outcomes provide further evidence for the long-term stability of type-I and type-II Boston keratoprostheses in the management of patients in whom a traditional graft is likely to fail.

  • Cornea
  • Prosthesis
  • Treatment Surgery

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