UC

Dav

isLong-Term Outcomes Long-Term Outcomes

of the Boston Type I of the Boston Type I

KeratoprosthesisKeratoprosthesis

Jennifer Li, M.D., Mark Greiner, M.D.Ana Carolina Vieira, M.D.

Mark Mannis, M.D.

University of California, DavisSacramento, California

The authors have no financial interest in the subject matter of this poster.

UC

Dav

isStudy Purpose

• To evaluate long-term outcomes

after placement of Boston type 1

keratoprosthesis

• To determine the types and

frequency of complications that

may develop postoperatively

UC

Dav

isMaterials and Methods

• A retrospective chart review of all

Boston type 1 keratoprosthesis

surgeries performed at a single

institution (UC Davis) beginning in

May, 2004 through January, 2010

UC

Dav

isBoston Keratoprosthesis

UC Davis, 2004-2010

Demographics

Number of eyes 40

Number of patients 35

Average age52.9 years

(range 2-86 years)

Gender57% M43% F

Average follow-up time 30.1 months

UC

Dav

isPatient Demographics

Preoperative Corneal Diagnosis # Eyes (%) Avg. # Prior PKPs

Chemical burn 10 (25.0%) 1.6

Failed graft NOS 7 (17.5%) 2.3

Aniridia 5 (12.5%) 1.6

Keratoconus 4 (10.0%) 3.0

HSV 4 (10.0%) 2.5

Congenital hereditary endothelial dystrophy

2 (5.0%) 1.0

Other

Thermal burn, Apert’s syndrome, ocular cicatricial pemphigoid, Peters, Stevens-Johnson, rheumatoid arthritis, Fuchs endothelial dystrophy, HLA-B27

uveitis

8 (20.0%) 2.3

Total 40 (100%) 2.0

UC

Dav

isPreoperative BCVA

0

2

4

6

8

10

12

14

LP HM CF 20/400 20/200 20/150 F&F(Fixates

&Follows)

Num

ber

of P

atie

nts

UC

Dav

isPreoperative Glaucoma

Preoperative Glaucoma

Number of eyes with glaucoma (%)

23 (57.5%)

Average number of preop glaucoma medications

1.52

Number of eyes with prior glaucoma surgery (%)

14 (35%)

UC

Dav

isPreoperative versus Postoperative BCVA

0

2

4

6

8

10

12

14

16

>20/50 20/50-20/100

20/150-20/200

20/400 CF HM LP NLP

Nu

mb

er

of

Pa

tien

ts

Postoperative

Preoperative

UC

Dav

isPostoperative BCVA Changes:

Comparing pre-op to final post-op BCVA

0%

10%

20%

30%

40%

50%

Improved ≥ 3 Lines Unchanged +/- 3 Lines Worsened ≥ 3 Lines orNLP

Perc

enta

ge o

f Eye

s (N

=40)

UC

Dav

isPostoperative Complications

Complications of K-Pro # Eyes (%)

Retroprosthetic membrane 22 (55.0%)

YAG laser membranectomy 10 (25.0%)

Surgical membranectomy 5 (12.5%)

Endophthalmitis 5 (12.5%)

Glaucoma 31 (77.5%)*

Progression 11 (27.5%)

GDD placement (excluding concomitant GDDs)

1 (2.5%)

GDD erosion 8 (20.0%)**

Transscleral cyclophotocoagulation 2 (5.0%)

Endocyclophotocoagulation 3 (7.5%)

End-stage glaucoma 7 (17.5%)

Corneal melt with K-Pro extrusion 6 (15.0%)

Replacement of K-Pro 7 (17.5%)

Removal of K-Pro 3 (7.5%)

**7 of 8 GDD erosions required revision and/or removal of device.

*23 (57.5%) had preoperative glaucoma diagnosis.

UC

Dav

is

Retroprosthetic Membrane

Exposed Tube Shunt

Periprosthetic Infiltrate

Extrusion of Keratoprosthesis

UC

Dav

isConclusions

• High percentage of patients have long-term BCVA equal to or

better than pre-operative visual acuity

• There is a moderately high percentage of patients with long-term

complications status post Boston type 1 keratoprosthesis

placement

• Progression of glaucoma and complications related to glaucoma

can be visually devastating

• Although many patients may benefit from keratoprosthesis

placement, long-term visual prognosis is guarded.

• Successful management of these patients requires pre- and

post-operative collaboration with glaucoma and vitreoretinal

specialists

• Further study is needed to determine the best means of

managing postoperative glaucoma