Outcomes of Boston Type I Keratoprosthesis in Stevens-Johnson Syndrome
Narrative Responses:
Purpose
To determine the post-operative outcomes of Boston type I keratoprosthesis (KPro) implantation in patients with Stevens-Johnson syndrome (SJS).
Methods
A retrospective, interventional case series of 153 KPro procedures performed by a single surgeon at the Jules Stein Eye Institute between May 2004 and August 2013. Preoperative characteristics and postoperative outcomes, including visual acuity, KPro retention and complications, were determined for procedures performed in patients with SJS and compared to patients without SJS.
Results
Eighteen KPro procedures were performed in 10 eyes of 9 SJS patients (mean follow-up 27 months; range 0.5–90 months). CDVA was >20/60 in 5/7 eyes with a retained KPro. The percentage of KPros retained at 6 months and annually between 1 and 5 years after surgery was 65%, 50%, 33%, 33%, 43% and 33%, respectively. The most common post-operative complications were persistent epithelial defects (PED) (89%), corneal stromal necrosis (61%) and retroprosthetic membrane formation (28%). All 11 KPro explantations were performed for donor corneal necrosis, with pathology suggestive of fungal keratitis in 3. No eyes developed endophthalmitis.
Conclusion
While the Boston type I keratoprosthesis provides similar improvement in CDVA in patients with SJS compared to other indications, the KPro retention failure rate is significantly higher. However, repeat KPro implantation can maintain significant visual improvement in these eyes that are not candidates for other forms of visual rehabilitation.