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Boston keratoprosthesis type I in the elderly
  1. Gelareh Homayounfar,
  2. Christina M Grassi,
  3. Ahmad Al-Moujahed,
  4. Kathryn A Colby,
  5. Claes H Dohlman,
  6. James Chodosh
  1. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr James Chodosh, Massachusetts Eye and Ear Infirmary, Howe Laboratory, Harvard Medical School, 243 Charles Street, Boston MA 02114, USA; james_chodosh{at}meei.harvard.edu

Abstract

Background/aims To determine the outcomes of Boston type I keratoprosthesis implanted in elderly patients.

Methods A retrospective case series was performed on patients at least 75 years old who received the Boston type I keratoprosthesis between 1 January 2007 and 31 December 2012. Preoperative diagnosis, interval visual acuity, keratoprosthesis retention and postoperative complications were recorded for each patient.

Results Forty-four Boston type I keratoprostheses were implanted in 44 eyes of 43 patients. The most common indication for surgery was corneal graft failure (n=23; 52.3%) followed by corneal scar (n=8; 18.2%) and limbal stem cell dysfunction (n=8; 18.2%). All patients had preoperative visual acuity of ≤20/200. Thirty-six of 44 (82%) patients achieved visual acuity of 20/200 or better postoperatively, and 20 of those (55.6%) maintained 20/200 or better for 1 year after surgery. The median length of follow-up was 825 days (range: 27–2193 days), and at the last follow-up visit, 20 of 44 (45.5%) had 20/200 or better vision. The median best-corrected visual acuity (logMAR) improved from 2.6 preoperatively to 1.0 at 1 year postoperative (p<0.00001). Device retention at 1 year postoperative was 88.9%. The most common postoperative complications were retroprosthetic membrane formation in 20 patients (45.5%) and cystoid macular oedema in six patients (13.6%). One patient developed keratitis and consecutive endophthalmitis 2 months after surgery and required enucleation.

Conclusions Boston type I keratoprosthesis is an effective modality in corneal blindness in elderly patients. Failure to restore or maintain ambulatory vision was typically due to non-corneal comorbidities, often unrelated to the keratoprosthesis.

  • Prosthesis
  • Cornea
  • Treatment Surgery

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