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Boston Keratoprosthesis Type 1 for Herpes Simplex and Herpes Zoster Keratopathy

Brown, Curtis R. MD; Wagoner, Michael D. MD, PhD; Welder, Jeffrey D. MD; Cohen, Alex W. MD, PhD; Goins, Kenneth M. MD; Greiner, Mark A. MD; Kitzmann, Anna S. MD

doi: 10.1097/ICO.0000000000000164
Clinical Science

Purpose: The aim of this study was to evaluate and compare the outcomes of Boston keratoprosthesis type 1 (Kpro-1) in eyes with herpes simplex virus (HSV) and herpes zoster virus (HZV) keratopathy.

Methods: A retrospective review was performed of the medical records of every patient treated with a Boston Kpro-1 at the University of Iowa Hospitals and Clinics between January 1, 2008 and July 1, 2012. Eyes with visual loss due to HSV or HZV keratopathy were included in the statistical analysis. The main outcome measures were graft retention, postoperative complications, and visual outcome.

Results: Nine eyes met the inclusion criteria, including 5 eyes in the HSV group and 4 eyes in the HZV group. The graft retention rate was 100% in the HSV group after a mean follow-up of 48.4 months, compared with 25% in the HZV group after 50.5 months (P = 0.048). There were 3 cases of microbial keratitis, including 2 eyes that also developed endophthalmitis, in the HZV group, compared with no cases in the HSV group (P = 0.048). There was significantly better best-corrected visual acuity at the most recent examination in the HSV group than in the HZV group (P = 0.019). All 5 HSV eyes had improved best-corrected visual acuity compared with preoperative acuity, whereas only 1 HZV eye experienced a similar result (P = 0.048).

Conclusions: Kpro-1 is associated with an excellent prognosis for graft retention, acceptably low prevalence of sight-threatening complications, and highly satisfactory visual improvement in eyes with HSV keratopathy, but not in eyes with HZV keratopathy.

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

Dean McGee Eye Institute, Oklahoma City, OK.

Reprints: Anna S. Kitzmann, MD, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242 (e-mail:

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

Received March 23, 2014

Accepted April 22, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.