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Boston Keratoprosthesis Outcomes in Severe Ocular Chemical Burns in Southern China: A Retrospective Study

Abstract

Introduction

The objective of this study was to report clinical outcomes (functional and anatomic) of Boston keratoprosthesis (KPro) after severe chemical burns in Southern China.

Methods

Nineteen patients (19 eyes) that sustained severe chemical injuries in Southern China were enrolled in this retrospective study in our hospital between May 2009 and June 2015. KPro implantation in these patients was performed by a single experienced surgeon (Jiaqi Chen). The parameters evaluated in this study included diagnosis, comorbidity, preoperative and postoperative visual acuity (VA), complications, KPro retention, histological and immunohistochemical results of retroprosthetic membrane (RPM) and mucous membrane over the optic cylinder.

Results

The mean age of the patients was 42.7 ± 11.3 years (range 29–62 years). All patients were male. Of the 19 included eyes, nine had acid burns, and 10 had alkali burns. Ten patients had previously undergone failed penetrating keratoplasty. The mean follow-up time was 41.3 ± 5.5 months (range 36–56 months). Preoperatively, the VA of the patients ranged from hand movement to light perception. Postoperatively, 17 patients (89.4%) achieved at least 20/200 once, and 7 patients (36.8%) achieved at least 20/200 and maintained this acuity until the last follow-up. The initial KPro was retained in 14 (73.6%) eyes and successfully replaced in one eye. Postoperative complications included RPM in 10 eyes, glaucoma in 6 eyes, retinal detachment in 2 eyes, corneal melting in 5 eyes, ischemic optic neuropathy in 1 eye, and overgrowth of the mucous membrane over the optical cylinder in 2 eyes. The histological and immunohistochemical results of the RPM showed granulomatous disorders and mucous membrane over the optic cylinder of conjunctival origin.

Conclusion

KPro surgery can restore useful vision in patients suffering from severe chemical burns. However, postoperative VA declined with the development of complications, and ocular surface disorders caused by the chemical burns were associated with a greater incidence of KPro retention failure. The retention rate was comparable in patients using ipsilateral autologous corneal tissue with allograft corneal tissue.

Funding

Science and Technology Foundation of Guangdong Province of China, Grant Number 2014A020212714.

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Acknowledgments

The authors would like to thank Engineer Chongfei Huang for his assistance with the temporary keratoprosthesis. Sponsorship and article processing charges for this study were supported by the Science and Technology Foundation of Guangdong Province of China, Grant Number 2014A020212714. This manuscript has been copyedited by American Journal Experts for language usage, spelling, and grammar. Processing charges were supported by the Science and Technology Foundation of Guangdong Province of China, Grant Number 2014A020212714.

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Disclosures

Jianjun Gu, Jiajie Zhai, Sheng Zhou and Jiaqi Chen have nothing to disclose.

Compliance with Ethics Guidelines

The study received approval from the Institutional Review Board of Zhongshan Ophthalmic Center, Sun Yat-sen University. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2013. Informed consent was obtained from all patients for being included in the study.

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Correspondence to Jiaqi Chen.

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Gu, J., Zhai, J., Zhou, S. et al. Boston Keratoprosthesis Outcomes in Severe Ocular Chemical Burns in Southern China: A Retrospective Study. Adv Ther 33, 760–773 (2016). https://doi.org/10.1007/s12325-016-0330-9

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Keywords

  • Boston keratoprosthesis
  • Chemical burns
  • Glaucoma
  • Ophthalmology
  • Retention
  • Visual acuity