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Gamma-Irradiated Corneas as Carriers for the Boston Type 1 Keratoprosthesis: Advantages and Outcomes in a Surgical Mission Setting

Fadlallah, Ali MD, MSc, MPH; Atallah, Marwan MD; Cherfan, George MD; Awwad, Shady T. MD; Syed, Zeba A. BA; Melki, Samir A. MD, PhD

doi: 10.1097/ICO.0000000000000065
Clinical Science

Purpose: The Boston keratoprosthesis (KPro) is the most commonly used KPro worldwide. There are limited data on the outcomes when irradiated corneas are used as KPro carriers. We report a retrospective analysis of corneal transplantations performed in a regular surgical mission setting in Beirut, Lebanon, using the Boston KPro type 1 and gamma-irradiated carrier corneas, and we describe visual outcomes, complications, and retention percentage.

Methods: We conducted a retrospective analysis of 17 consecutive eyes from 16 patients who underwent Boston KPro type 1 implantation at the Beirut Eye Specialist Hospital between December 2010 and July 2012. Patient medical records were reviewed for preoperative, intraoperative, and postoperative details.

Results: Postoperatively, 9 (52.9%), 5 (29.4%), and 2 (11.7%) eyes had a corrected visual acuity of 20/400 or better, 20/100 or better, and 20/40 or better, respectively, at the most recent follow-up visit. A total of 16 eyes (94.1%) improved in corrected visual acuity over the course of follow-up. Overall, 13 eyes (76.4%) developed at least 1 complication after surgery. Retroprosthetic membrane formation was the most common complication, occurring in 10 eyes (58.8%). Neither infectious keratitis nor corneal stromal necrosis was noted during the follow-up period. The retention percentage was 94.1%.

Conclusions: The visual acuity outcomes, incidence of complications, and retention percentage of the KPro using gamma-irradiated carrier corneas are comparable with the outcomes of KPro implantation reported in the literature using fresh grafts as carriers. KPro with irradiated corneal carrier grafts seems to be an effective option to increase the supply of transplantation suitable corneas in remote areas, where fresh corneal grafts may be scarce.

*Beirut Eye Specialist Hospital, Beirut, Lebanon;

Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon, and UPMC, Sorbonne University, Paris, France;

American University of Beirut Medical Center, Opthalmology Department, Beirut, Lebanon;

§Harvard Medical School, Boston, MA; and

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Reprints: Samir A. Melki, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (e-mail: samir_melki@meei.harvard.edu).

The authors have no funding or conflicts of interest to disclose.

Received January 28, 2013

Accepted December 06, 2013

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