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Boston Type 1 Keratoprosthesis for Chemical and Thermal Injury

Phillips, David L. MD; Hager, Jonathan L. MD; Goins, Kenneth M. MD; Kitzmann, Anna S. MD; Greiner, Mark A. MD; Cohen, Alex W. MD, PhD; Welder, Jeffrey D. MD; Wagoner, Michael D. MD, PhD

doi: 10.1097/ICO.0000000000000204
Clinical Science

Purpose: To evaluate the outcome of the Boston type 1 keratoprosthesis (Kpro-1) in eyes with failed interventions for chemical and thermal injury.

Methods: A retrospective review was performed of every eye with chemical or thermal injury that was treated with a Kpro-1 at a tertiary eye care center between January 1, 2008 and July 1, 2013. The main outcome measures were visual outcome, prosthesis retention, and postoperative complications.

Results: Nine eyes met the inclusion criteria, including 7 eyes with alkali burns, 1 eye with an acid burn, and 1 eye with a thermal burn. After a mean follow-up of 40.7 months (range, 29–60 months), the median best-corrected visual acuity was 20/60 (range, 20/15 to no light perception). One eye was ≥20/20, 3 eyes were ≥20/40, and 6 eyes were ≥20/70. The initial Kpro-1 prosthesis was retained in 7 (77.7%) eyes and successfully replaced in the other 2 eyes. One or more serious complications occurred in 6 (66.7%) eyes. These included 2 cases of sterile corneal ulceration with prosthesis extrusion, 2 cases of microbial keratitis (1 bacterial and 1 fungal), 2 cases of bacterial endophthalmitis, and 2 cases of retinal detachments. These complications contributed to visual outcomes of hand motions in 2 eyes and no light perception in 1 eye.

Conclusions: The Boston Kpro-1 is associated with highly satisfactory visual outcomes and prosthesis retention in most cases of severe chemical or thermal injury. Serious complications are common and may compromise the final outcome.

*Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA; and

Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK.

Reprints: Michael D. Wagoner, MD, PhD, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 (e-mail: michael-wagoner@uiowa.edu).

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

Received April 30, 2014

Accepted June 10, 2014

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