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Treatment of Oculoplastic and Ocular Surface Disease in Eyes Implanted with a Type I Boston Keratoprosthesis in Southern China: A Retrospective Study

Abstract

Introduction

This study aimed to describe the clinical features, surgical management of the eyelid and ocular surface, and outcomes of 16 patients implanted with a Boston type I keratoprosthesis (KPro).

Methods

A retrospective, single-center, consecutive case series of 16 patients with Stevens–Johnson syndrome (1), ocular chemical burns (12), and ocular thermal burns (3) implanted with KPro was studied. All subjects were men aged 27–51 years. Surgical treatment and outcomes for eyelid malposition, symblepharon, and glaucoma were assessed.

Results

From September 2010 to February 2019, 29 patients were admitted to Zhongshan Ophthalmic Center for KPro implantation, of whom 16 (55%) required eyelid or ocular surface surgeries to maintain hydration and protect the corneal tissue, which is vulnerable to epithelial defects. Forty-one adnexal surgical procedures were performed. The most common indication for surgery was symblepharon, and the most frequent procedures were symblepharon lysis with ocular mucous membrane grafts and amniotic membranes (7) and full-thickness skin grafts to the eyelids (7). Preoperative conjunctival injection and corneal staining were documented in 9 (56%) and 8 (50%) eyes, respectively, and at up to 4 months postoperative follow-up (the last adnexal surgery before KPro) were recorded in 3 (19%, p = 0.03) and 2 (12%, p = 0.02) eyes, respectively. Glaucoma drainage devices were inserted in six patients. One patient with Stevens–Johnson syndrome underwent FP7 Ahmed glaucoma valve (AGV) implantation inferotemporally and developed plate exposure 2 months postoperatively. Five patients underwent FP8 AGV implantation with tube insertion into the vitreous cavity due to the scarred conjunctiva and limited subconjunctival space. In the study period, intraocular pressure (IOP) was in the normal range, and no tube or plate exposure was observed.

Conclusion

The ocular environment is critical for successful KPro surgery. A multidisciplinary approach for any lid and ocular surface abnormality in ocular burns or Stevens–Johnson syndrome is important to improve the quality of the ocular surface and accommodate KPro and AGV, which is vital for maintaining vision after KPro surgery. FP8 AGV may be feasible for IOP control in adult KPro cases with restricted subconjunctival space.

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Acknowledgements

We hereby thank all the participants of the study.

Funding

No funding or sponsorship was received for this study or publication of this article. The Rapid Service Fee was funded by the authors.

Medical Writing Assistance

Language editing and assistance for this article were provided by AJE and funded by the authors.

Authorship

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

Disclosures

Yuying Zhang, Zhancong Ou, Jin Zhou, Jiajie Zhai, Jianjun Gu and Jiaqi Chen have nothing to disclose.

Compliance with Ethics Guidelines

This study was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments and was approved by the Ethics Committee of Zhongshan Ophthalmic Center. Informed consent for participation and publication of patient data was obtained from all individual participants included in the study. Permissions have been obtained from our patients to publish the images of patients in this article.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Correspondence to Jianjun Gu.

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Zhang, Y., Ou, Z., Zhou, J. et al. Treatment of Oculoplastic and Ocular Surface Disease in Eyes Implanted with a Type I Boston Keratoprosthesis in Southern China: A Retrospective Study. Adv Ther 37, 3206–3222 (2020). https://doi.org/10.1007/s12325-020-01381-3

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  • DOI: https://doi.org/10.1007/s12325-020-01381-3

Keywords

  • Acellular dermis
  • Ahmed glaucoma valve
  • Boston keratoprosthesis
  • Glaucoma
  • Ocular burns
  • Ocular surface
  • Oculoplastic surgery
  • Pars plana vitrectomy