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Boston Keratoprosthesis Type 1 in the Pediatric Population

  • Ocular Prosthesis (J. De la Cruz, Section Editor)
  • Published:
Current Ophthalmology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Pediatric corneal blindness is a worldwide problem that is very difficult to address. Traditional penetrating keratoplasty is considered a high-risk procedure in this population due to the host of complications that are often encountered. Even when anatomic success is achieved with penetrating keratoplasty, visual recovery is not guaranteed.

Recent Findings

Pediatric keratoprosthesis is an alternative procedure that offers rapid visual recovery in a quiet eye without the risk of allograft rejection. Visually significant complications, including glaucoma, retinal detachments, retroprosthetic membranes, and endophthalmitis, can occur. Extreme care should be taken in selecting appropriate candidates for pediatric keratoprosthesis surgery.

Summary

Success with pediatric keratoprosthesis surgery can be achieved with a dedicated team of ophthalmic specialists and a motivated family.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96(5):614–8.

    Article  PubMed  Google Scholar 

  2. Ament JD, Todani A, Pineda R II, Shen TT, et al. Global corneal blindness and the boston keratoprosthesis type I. Am J Ophthalmol. 2010;149(4):537–9.

    Article  PubMed  Google Scholar 

  3. Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a global perspective. Bull World Health Organ. 2001;79(3):214–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Huang C, O’Hara M, Mannis MJ. Primary pediatric keratoplasty: indications and outcomes. Cornea. 2009;28(9):1003–8.

    Article  PubMed  Google Scholar 

  5. Stulting RD, Sumers KD, Cavanagh HD, Waring GO 3rd, Gammon JA. Penetrating keratoplasty in children. Ophthalmology. 1984;91(10):1222–30.

    Article  CAS  PubMed  Google Scholar 

  6. Nallasamy S, Colby K. Keratoprosthesis: procedure of choice for corneal opacities in children? Semin Ophthalmol. 2010;25(5–6):244–8.

    Article  PubMed  Google Scholar 

  7. Vanthi M, Panda A, Vengayil S, Chaudhuri Z, Dada T. Pediatric keratoplasty. Surv Ophthalmol. 2009;54(2):245–71.

    Article  Google Scholar 

  8. Dana MR, Moyes AL, Gomes JA, et al. The indications for and outcome in pediatric keratoplasty. A Multicenter Study. Ophthalmology. 1995;102(8):1129–38.

    Article  CAS  PubMed  Google Scholar 

  9. Aquavella JV, Gearinger MD, Akpek EK, McCormick GJ. Pediatric keratoprosthesis. Ophthalmology. 2007;114(5):989–94.

    Article  PubMed  Google Scholar 

  10. • Colby KA, Koo EB. Expanding indications for the Boston keratoprosthesis. Curr Opin Ophthalmol. 2011;22(4):267–73. This paper describes expanding indications for the Boston keratoprosthesis including a section on pediatric use.

  11. Low JR, Anshu A, Tan AC, Htoon HM, Tan DT. The outcomes of primary pediatric keratoplasty in Singapore. Am J Ophthalmol. 2014;158(3):496–502.

    Article  PubMed  Google Scholar 

  12. Al-Ghamdi A, Al-Rajhi A, Wagoner MD. Primary pediatric keratoplasty: indications, graft survival, and visual outcome. J AAPOS. 2007;11(1):41–7.

    Article  PubMed  Google Scholar 

  13. Dohlman CH. Guillaume Pellier de Quengsy. In: Corneal Transplantation: A History in Profiles. Belgium: J.P. Wayenborgh, 1999;53–63

  14. Gomaa A, Comyn O, Liu C. Keratoprostheses in clinical practice—a review. Clin Experiment Ophthalmol. 2010;38(2):211–24.

    Article  PubMed  Google Scholar 

  15. Lekhanont K, Panday V, Akpek EK. Corneal surgery: theory, technique and tissue. 4th ed. St. Louis: Mosby Elsevier; 2009. p. 683–90.

    Google Scholar 

  16. Dohlman CH, Harissi-Dagher M, Graney J. The Boston keratoprosthesis: a new threadless design. Digit J Ophthalmol. 2007;13:6.

    Google Scholar 

  17. Waller SG, Dohlman CH. Corneal surgery: theory, technique and tissue. 4th ed. St. Louis: Mosby Elsevier; 2009. p. 691–6.

    Google Scholar 

  18. Cruzat, A. in Boston Kpro News Vol. 11 (Harvard Medical School Department of Ophthalmology/Massachusetts Eye and Ear Infirmary, 2015).

  19. Ciolino JB, Belin MW, Todani A, Al-Arfaj K, Rudnisky CJ. Retention of the Boston keratoprosthesis type 1: multicenter study results. Ophthalmology. 2013;120(6):1195–200.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rudnisky CJ, Belin MW, Guo R, Ciolino JB. Visual acuity outcomes of the Boston keratoprosthesis type 1: multicenter study results. Am J Ophthalmol. 2016;162:89–98.

    Article  PubMed  Google Scholar 

  21. •• Lee WB, Shtein RM, Kaufman SC, et al. Boston keratoprosthesis: outcomes and complications: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(7):1504–11. This is a meta-analysis of studies reporting on the safety and outcomes of the Boston Keratoprosthesis Type I.

  22. Srikumaran D, Munoz B, Aldave AJ, Aquavella JV, Hannush SB, Schultze R, Belin M, Akpek EK. Long-term outcomes of boston Type I keratoprosthesis implantation: a retrospective multicenter cohort. Ophthalmology. 2014;121(11):2159–64.

    Article  PubMed  Google Scholar 

  23. Zaidman GW. Corneal surgery: theory, technique and tissue. 4th ed. St. Louis: Mosby Elsevier; 2009. p. 431–8.

    Google Scholar 

  24. Dunlap K Chak, Aquavella JV G, et al. Short-term visual outcomes of Boston type 1 keratoprosthesis implantation. Ophthalmology. 2010;117(4):687–92.

    Article  PubMed  Google Scholar 

  25. Dohlman CH, Dudenhoefer EJ, Khan BF, Morneault S. Protection of the ocular surface after keratoprosthesis surgery: the role of soft contact lenses. CLAO. 2002;28(2):72–4.

    Google Scholar 

  26. Birch EE, Cheng C, Stager DR, et al. The critical period for surgical treatment of dense congenital bilateral cataracts. J AAPOS. 2009;13:67–71.

    Article  PubMed  Google Scholar 

  27. Kang JJ, de la Cruz J, Cortina MS. Visual outcomes of Boston keratoprosthesis implantation as the primary penetrating corneal procedure. Cornea. 2012;31(12):1436–40.

    Article  PubMed  Google Scholar 

  28. Fadous R, Levallois-Gignac S, Vaillancourt L, et al. The Boston Keratoprosthesis type 1 as primary penetrating corneal procedure. Br J Ophthalmol. 2015;99(12):1664–8.

    Article  PubMed  Google Scholar 

  29. Ahmad S, Mathews PM, Lindsley K, et al. Boston Type 1 keratoprosthesis versus repeat donor keratoplasty for corneal graft failure: a systematic review and meta-analysis. Ophthalmology. 2016;123(1):165–77.

    Article  PubMed  Google Scholar 

  30. Cruzat A, Shukla A, Dohlman CH, Colby K. Wound anatomy after type 1 Boston KPro using oversized back plates. Cornea. 2013;32:1531–6.

    Article  PubMed  Google Scholar 

  31. Botelho PJ, Congdon NG, Handa JT, Akpek EK. Keratoprosthesis in high-risk pediatric corneal transplantation: first 2 cases. Arch Ophthalmol. 2006;124:1356–7.

    Article  PubMed  Google Scholar 

  32. Bakhtiari P, Chan C, Welder JD, et al. Surgical and visual outcomes of the type I Boston Keratoprosthesis for the management of aniridic fibrosis syndrome in congenital aniridia. Am J Ophthalmol. 2012;153:967–71.

    Article  PubMed  Google Scholar 

  33. Iyer G, Srinivasan B, Gupta N, Padmanabhan P. Outcome of Boston keratoprosthesis in a developing country-importance of patient selection, education, and perioperative care: the Indian experience. Asia Pac J Ophthalmol. 2012;1(4):202–7.

    Article  Google Scholar 

  34. • Rachitskaya AV, Moysidis SN, Miller D, et al. Streptococcal endophthalmitis in pediatric keratoprosthesis. Ophthalmology. 2013;120:1506–07. This is the first study to report infectious complications with pediatric keratoprosthesis implantation.

  35. Bradley JC, Hernandez EG, Schwab IR, Mannis MJ. Boston type 1 keratoprosthesis: the university of california davis experience. Cornea. 2009;28(3):321–7.

    Article  PubMed  Google Scholar 

  36. Li JY, Greiner MA, Brandt JD, et al. Long-term complications associated with glaucoma drainage devices and Boston keratoprosthesis. Am J Ophthalmol. 2011;152:209–18.

    Article  PubMed  Google Scholar 

  37. Greiner MA, Li JY, Mannis MJ. Longer-term vision outcomes and complications with the Boston type 1 keratoprosthesis at the University of California Davis. Ophthalmology. 2011;118:1543–50.

    Article  PubMed  Google Scholar 

  38. Aquavella JV, Qian Y, McCormick GJ, Palakuru JR. Keratoprosthesis: current techniques. Cornea. 2006;25:656–62.

    Article  PubMed  Google Scholar 

  39. Aldave AJ, Sangwan VS, Basu S, et al. International results with the Boston type I keratoprosthesis. Ophthalmology. 2012;119:1530–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cornea Service, Department of Ophthalmology, Weill Cornell Medical College, 1305 York Ave, 11th Floor, New York, NY, 10021, USA

    Thomas Dohlman, Ana Alzaga Fernandez, Buntitar Lertsuwanroj & Jessica Ciralsky

Authors
  1. Thomas Dohlman
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  2. Ana Alzaga Fernandez
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  3. Buntitar Lertsuwanroj
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  4. Jessica Ciralsky
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Corresponding author

Correspondence to Jessica Ciralsky.

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Disclosure

This investigation was supported by an unrestricted grant from Research to Prevent Blindness. Dr. Ciralsky: Consultant for Allergan, AMO, Shire. Buntitar Lertsuwanroj, Thomas Dohlman, Jessica Ciralsky, and Ana Alzaga Fernandez declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical collection on Ocular Prosthesis.

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Dohlman, T., Fernandez, A.A., Lertsuwanroj, B. et al. Boston Keratoprosthesis Type 1 in the Pediatric Population. Curr Ophthalmol Rep 4, 124–130 (2016). https://doi.org/10.1007/s40135-016-0103-2

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  • DOI: https://doi.org/10.1007/s40135-016-0103-2

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