Outcomes of Boston Keratoprosthesis Type 1 in Management of Congenital Aniridic Keratopathy
Narrative Responses:
Purpose
To report the outcomes of Boston keratoprosthesis (K-pro) Type 1 in the management of congenital aniridic keratopathy.
Methods
An observational, retrospective review was performed on 56 eyes (43 patients) with congenital aniridia that underwent Boston K-pro type 1 implantation at a single institution between 2004 and 2012. The primary outcome measurements were graft retention rate, change in visual acuity, and post operative complications, specifically retroprosthetic membrane formation and glaucoma progression.
Results
56 eyes (43 patients) were included. The mean age was 43.3 years (Range 11-76 years). The average postoperative follow-up period was 24.1 months. Overall graft retention rate was 85.7%. Retroprosthetic membrane formation was 37.5% (21/56).
Rate of pre-operative glaucoma was 75.0% (42/56 ). Eyes with pre-operative glaucoma drainage implants was 51.7% (29/56). 24.1% of these eyes (7/29) exhibited post-operative tube erosion requiring surgical intervention. A significant number experienced complications from postoperative aniridic fibrosis syndrome, including hypotony and retinal detachment (11/56; 19.6%).
Compared with preoperative best corrected visual acuity, 71.4% (40/56) of eyes improved, 14.3% (8/56) were unchanged, and 14.3% (8/56) exhibited worse vision.
Conclusion
Boston keratoprosthesis Type 1 is an option for aniridic keratopathy. This option is best reserved for elderly patients due to postoperative sequelae, including progressive glaucoma, lifelong risk for erosion/infection, and complications from aniridic fibrosis syndrome. In younger patients, we recommend unilateral implantation until long-term data of postoperative complications is known.