Skip to main content
SpringerLink
Log in

Four-year outcomes and complications of Boston keratoprosthesis type I implantation in the Middle East

Vier-Jahres-Ergebnisse und Komplikationen bei der Implantation von Boston Keratoprothesen Typ I im Nahen Osten

  • original article
  • Published:
Spektrum der Augenheilkunde Aims and scope Submit manuscript

Summary

Objective

The objective of this study was to present 4-year outcomes and complications after Boston keratoprosthesis (B-KPro) type I implantation in patients from the Middle East region.

Material and methods

In total, 16 eyes of 16 patients (mean age: 56.3 ± 4.1 years), who had undergone B-KPro type I implantation and completed 4 years of follow-up, were retrospectively reviewed.

Results

B-KPro was performed as a secondary procedure in 50 % (8 of 16) of the eyes due to prior graft failure and primary procedure in 50 % (8 of 16) of the eyes, including two eyes with ocular cicatricial pemphigoid, one eye with chemical burn, and five eyes with severe corneal vascularization due to trachoma. Preoperative comorbidities included glaucoma in 56.3 % (9 of 16) of the eyes. Corneal melts developed in three eyes postoperatively. Other complications included retroprosthetic membrane (RPM) in 50 % (8 of 16), worsening of glaucoma in 18.8 % (3 of 16), vitreous hemorrhage in 12.5 % (2 of 16), and sterile vitritis in 6.3 % (1 of 16) of the eyes. The retention rate in the current study was 81.3 % (13 of 16), with a visual acuity of ≥ 20/200 in 68.8 % (11 of 16) of the eyes at 4-year follow-up.

Conclusions

After a long-term follow-up of 4 years, B-KPro type I implantation improved and maintained vision, both as a secondary procedure in patients with multiple graft failures and primary procedure in conditions with poor prognosis for corneal transplantation. However, the outcomes in cases with autoimmune disorders are less favorable. The retention rate found in the current case series is in agreement with previous reports from the Middle East as well as the other parts of the world.

Zusammenfassung

Ziel

Ziel der vorliegenden Studie war, 4-Jahres-Ergebnisse und Komplikationen nach Implantation von Boston Keratoprothesen (B-KPro) Typ I bei Patienten im Nahen Osten zu präsentieren.

Material und Methoden

Insgesamt wurden bei 16 Patienten (mittleres Alter: 56,3 ± 4,1 Jahre), die einer B-KPro Typ I Implantation unterzogen und vier Jahre nachbeobachtet worden waren, 16 Augen retrospektiv bewertet.

Ergebnisse

B-KPro wurde bei 50 % (n = 8) der Augen aufgrund von Transplantatversagen als Sekundärprozedur und bei 50 % (n = 8), inkl. 2 Augen mit okulärem vernarbendem Pemphigoid, 1 Auge mit chemischer Verätzung, sowie 5 Augen mit schwerwiegender trachombedingter kornealer Vaskularisation, als Primärprozedur durchgeführt. Präoperative Komorbiditäten waren u. a.Glaukome bei 56,3 % (n = 9) der Fälle. Zu den Komplikationen zählten auch retroprotethische Membrane bei 50 % (n = 8), fortgeschrittene Glaukome bei 18,8 % (n = 3), Glaskörperblutungen bei 12,5 % (n = 2), sowie eine sterile Vitritis bei 6,3 % (n = 1) der Augen. Die Retentionsrate in der vorliegenden Studie betrug 81,3 % (n = 13) mit einer Sehschärfe von ≥ 20/200 bei 68,8 % (n = 11) nach 4-jähriger Nachbeobachtung.

Schlussfolgerungen

Nach 4 Jahren Nachbeobachtung konnte mit einer B-KPro Typ I Implantation die Sehkraft verbessert und aufrechterhalten werden, sowohl im Sinne einer Sekundärprozedur bei Patienten mit multiplen Transplantatversagen als auch im Sinne einer Primärprozedur bei Vorliegen einer schlechten Prognose für eine Korneatransplantation. Allerdings sind die Ergebnisse in Fällen von Autoimmunerkrankungen weniger günstig. Die Retentionsrate in der vorliegenden Fallserie stimmt mit vorhergehenden Berichten aus dem Nahen Osten sowie dem Rest der Welt überein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aldave AJ, Kamal KM, Vo RC, et al. The Boston type I keratoprosthesis: improving outcomes and expanding indications. Ophthalmology. 2009;116(4):640–51.

    Article  PubMed  Google Scholar 

  2. Khan BF, Harissi-Dagher M, Khan DM, et al. Advances in Boston keratoprosthesis: enhancing retention and prevention of infection and inflammation. Int Ophthalmol Clin. 2007;47(2):61–71.

    Article  PubMed  Google Scholar 

  3. Khan BF, Harissi-Dagher M, Pavan-Langston D, et al. The Boston keratoprosthesis in herpetic keratitis. Arch Ophthalmol. 2007;125(6):745–9.

    Article  PubMed  Google Scholar 

  4. Kim MJ, Bakhtiari P, Aldave AJ. The international use of the Boston type I keratoprosthesis. Int Ophthalmol Clin. 2013;53(2):79–89.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Chew HF, Ayres BD, Hammersmith KM, et al. Boston keratoprosthesis outcomes and complications. Cornea. 2009;28(9):989–96.

    Article  PubMed  Google Scholar 

  7. Klufas MA, Colby KA. The Boston keratoprosthesis. Int Ophthalmol Clin. 2010;50(3):161–75.

    Article  PubMed  Google Scholar 

  8. Lam FC, Liu C. The future of keratoprostheses (artificial corneae). Br J Ophthalmol. 2011;95(3):304–5.

    Article  PubMed  Google Scholar 

  9. Magalhaes FP, Sousa LB, Oliveira LA. Boston type I keratoprosthesis: review. Arq Bras Oftalmol. 2012;75(3):218–22.

    Article  PubMed  Google Scholar 

  10. Colby KA, Koo EB. Expanding indications for the Boston keratoprosthesis. Curr Opin Ophthalmol. 2011;22(4):267–73.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Al Arfaj K, Hantera M. Short-term visual outcomes of Boston keratoprosthesis type I in Saudi Arabia. Middle East Afr J Ophthalmol. 2012;19(1):88–92.

  13. 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(8):1543–50.

    Article  PubMed  Google Scholar 

  14. Patel AP, Wu EI, Ritterband DC, et al. Boston type 1 keratoprosthesis: the New York Eye and Ear experience. Eye. 2012;26(3):418–25.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Sayegh RR, Ang LP, Foster CS, et al. The Boston keratoprosthesis in Stevens-Johnson syndrome. Am J Ophthalmol. 2008;145(3):438–44.

    Article  PubMed  Google Scholar 

  16. Dohlman CH, Harissi-Dagher M. The Boston keratoprosthesis: a new threadless design. Digit J Opthalmol. 2007;13(3). http://www.djo.harvard.edu/site.php?url=/physicians/oa/1055. Accessed June 30, 2014.

  17. Robert MC, Harissi-Dagher M. Boston type 1 keratoprosthesis: the CHUM experience. Can J Ophthalmol. 2011;46(2):164–8.

  18. Sejpal K, Yu F, Aldave AJ. The Boston keratoprosthesis in the management of corneal limbal stem cell deficiency. Cornea. 2011;30(11):1187–94.

    PubMed  Google Scholar 

  19. Zerbe BL, Belin MW, Ciolino JB, et al. Results from the multicenter Boston Type 1 Keratoprosthesis Study. Ophthalmology. 2006;113(10):1779.e1–7.

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

    Article  PubMed  Google Scholar 

  21. Jasinskas V, Rudalevicius P, Miliauskas A, et al. Keratoprosthesis surgery as an alternative to keratoplasty. Medicina. 2013;49(6):291–9.

    PubMed  Google Scholar 

  22. Shihadeh WA, Mohidat HM. Outcomes of the Boston keratoprosthesis in Jordan. Middle East Afr J Ophthalmol. 2012;19(1):97–100.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Ciolino JB, Belin MW, Todani A, et al. Retention of the Boston keratoprosthesis type 1: multicenter study results. Ophthalmology. 2013;120(6):1195–200.

    Article  PubMed Central  PubMed  Google Scholar 

  24. de la Paz MF, Stoiber J, de Rezende Couto Nascimento V, et al. Anatomical survival and visual prognosis of Boston type I keratoprosthesis in challenging cases. Graefes Arch Clin Exp Ophthalmol. 2014;252(1):83–90.

  25. Akpek EK, Harissi-Dagher M, Petrarca R, et al. Outcomes of Boston keratoprosthesis in aniridia: a retrospective multicenter study. Am J Ophthalmol. 2007;144(2):227–31.

    Article  PubMed  Google Scholar 

  26. Aquavella JV, Qian Y, McCormick GJ, et al. Keratoprosthesis: the Dohlman-Doane device. Am J Ophthalmol. 2005;140(6):1032–8.

    Article  PubMed  Google Scholar 

  27. Rudnisky CJ, Belin MW, Todani A, et al. Risk factors for the development of retroprosthetic membranes with Boston keratoprosthesis type 1: multicenter study results. Ophthalmology. 2012;119(5):951–5.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Verdejo-Gomez L, Pelaez N, Gris O, et al. The Boston Type I keratoprosthesis: an assessment of its efficacy and safety. Ophthalmic Surg Lasers Imaging. 2011;42(6):446–52.

    Article  PubMed  Google Scholar 

  29. Yaghouti F, Nouri M, Abad JC, et al. Keratoprosthesis: preoperative prognostic categories. Cornea. 2001;20(1):19–23.

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Dammam University, King Fahad University Hospital, PO Box 40033, Al Khobar, Zip code 31952, Saudi Arabia

    Khalid Al Arfaj MD

Authors
  1. Khalid Al Arfaj MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khalid Al Arfaj MD.

Ethics declarations

IrisARC—Analytics, Research & Consulting (Chandigarh, India) provided statistical analysis, writing, and editing assistance.

Conflict of interest

The author declares that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al Arfaj, K. Four-year outcomes and complications of Boston keratoprosthesis type I implantation in the Middle East. Spektrum Augenheilkd. 28, 238–242 (2014). https://doi.org/10.1007/s00717-014-0233-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00717-014-0233-6

Schlüsselwörter

Schlüsselwörter

Search

Navigation