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Contact Lens Fitting and Long-Term Management for the Boston Keratoprosthesis

Nau, Amy C. O.D.; Drexler, Scott O.D.; Dhaliwal, Deepinder K. M.D.; Mah, Francis M.D.; Raju, Leela M.D.; Deschler, Emily M.D.

Eye & Contact Lens: Science & Clinical Practice: May 2014 - Volume 40 - Issue 3 - p 185–189
doi: 10.1097/ICL.0000000000000021
Review

Objectives: To examine the types of contact lenses used as bandage lenses in the postoperative management of patients with Boston type 1 keratoprosthesis (K-Pro). We examined the lens parameters, the number of trial lenses used to achieve successful fit, and lens replacement schedule. The strategies to achieving a successful fit in these complex patients are reviewed.

Methods: This was a single-center, retrospective chart review of patients who had undergone implantation of the Boston keratoprosthesis in 1 or more eyes from January 2006 to December 2011. Patients included male and female subjects aged 18 years or older who had been fit with bandage contact lenses as part of their postoperative management.

Results: Twenty-two eyes of 15 patients met the criteria for this review. The age range was 30 to 90 years. There were eight men and seven women. The average number of lenses to achieve a successful fit varied from 1 to 8, with an average of 2.22 trial lenses used per patient. By 6 months after the surgery, 12 K-Pro eyes showed visual acuity of 20/200 or better, with 7 of those eyes attaining better than 20/80 best-corrected Snellen distance acuity.

Conclusions: Our results show that it is often necessary to use custom contact lenses for K-Pro patients. Management of poor tear film quality, protein deposition, inflammation, lens replacement schedule, and antibiotic resistance are related considerations.

UPMC Eye Center (A.C.N., S.D., D.K.D., L.R., E.D.), Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA; and Scripps Clinic (F.M.), La Jolla, CA.

Address correspondence to Amy C. Nau, O.D., UPMC Eye Center, 203 Lothrop Street, Suite 754, Pittsburgh, PA 15213; e-mail: nauac@upmc.edu

Supported by the National Institutes of Health CORE Grant P30 EY008098, the Eye and Ear Foundation of Pittsburgh, PA, and an unrestricted grant from the Research to Prevent Blindness, New York, NY.

A. C. Nau has received honoraria from Synergeyes, Inc., and SUNY College of Optometry. She is currently receiving grant support from the Department of Defense (W81XWH-10-1-0998) and is involved in a Food and Drug Administration (FDA) safety study sponsored by Wicab, Inc. D. K. Dhaliwal is an investigator in FDA studies sponsored by AMO and Avedro. F. Mah has been a consultant for Alcon, Inspire, and Ista. He has grants with Alcon and Inspire, has received payment for lectures from Alcon and Ista, and holds stock options with Ocular Therapeutix. The remaining authors have no conflicts of interest to disclose.

Accepted December 19, 2013

© 2014 Contact Lens Association of Ophthalmologists, Inc.