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Impact of type I Boston keratoprosthesis implantation on vision-related quality of life
  1. Marcus Ang1,2,3,4,
  2. Ryan Man3,
  3. Eva Fenwick2,3,
  4. Ecosse Lamoureux2,3,
  5. Mark Wilkins4,5
  1. 1Singapore National Eye Centre, Singapore
  2. 2Duke-NUS Medical School, Singapore
  3. 3Singapore Eye Research Institute, Singapore
  4. 4Moorfields Eye Hospital, London, UK
  5. 5Institute of Ophthalmology, University College London, London, UK
  1. Correspondence to Dr Marcus Ang, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore; marcus.ang{at}snec.com.sg

Abstract

Aim To determine the impact of type I Boston keratoprosthesis (KPro) implantation on vision-related quality of life (VRQoL).

Methods Prospective study in 33 patients (mean age 56±12 years, 67% male) with bilateral corneal blindness, who underwent a KPro implantation at a single tertiary eye hospital (June 2011–July 2015). VRQoL was evaluated using the Impact of Vision Impairment Questionnaire (IVI) at baseline and at 3–6 months postsurgery, after stabilisation of best-corrected visual acuity (BCVA). Rasch analysis was used to transform the IVI responses into interval-level measures comprising the ‘reading’, ‘mobility’ and ‘emotional’ subscales with effect sizes calculated for pre-post VRQoL scores.

Results Mean preoperative BCVA was counting-fingers at 2 feet in the operated eye (20/240 fellow eye). Preoperative VRQoL scores: −2.27, –2.91 and −3.06 logits for the reading, mobility and emotional subscales, respectively. Device retention rate was 90% over the follow-up period (mean 26±12 months). We observed large gains for reading and mobility of 1.92 logits (effect size 0.88), and 2.64 logits (effect size 0.89) respectively, with a moderate gain in the emotional subscale of 2.11 logits (effect size 0.59). These improvements did not vary significantly with BCVA on multivariate analysis (all p>0.05).

Conclusion We observed a differential short-term improvement to VRQoL after KPro implantation with a significant impact on emotional well-being, which may not be fully explained by visual improvement alone. Further studies are required to confirm if these improvements in VRQoL are sustained in the long-term and are generalisable to other populations.

  • Cornea
  • Prosthesis
  • Treatment Surgery

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Footnotes

  • Contributors All authors met the ICJME criteria: 1) substantial contributions to conception and design, acquisition of data or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content and 3) final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Moorfields Eye Hospital Ethical Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional unpublished data may be obtained from the corresponding author.

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