Skip to main content

Advertisement

SpringerLink
Log in

Retroprosthetic Membrane Formation After Boston Keratoprosthesis: Is It Truly a Benign Complication?

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

Abstract

Purpose of Review

Advances in Boston type 1 keratoprosthesis (K-Pro) technology and postoperative management have led to a decrease in postoperative complications and expanded indications in recent years. However, several challenges still remain, including the post-implantation development of fibrous tissue behind the device known as a retroprosthetic membrane (RPM). Herein, we review the epidemiology, pathophysiology, detection, treatment, prevention, and sequelae of RPM formation after keratoprosthesis implantation.

Recent Findings

Among postulated risk factors, device indication has been found to be a significant predictor of RPM formation. However, the etiology is likely multifactorial and probably involves both pathologic wound healing triggered by the device and host-specific factors. Anterior segment optical coherence tomography is emerging as a useful tool in the detection and monitoring of RPM formation. Once diagnosed, most RPMs affecting vision are responsive to therapy. However, attempts to reduce the burden of RPM formation including the utility of intracameral corticosteroid prophylaxis at the time of surgery have shown limited effect. Beyond visual impairment, evidence suggests that membrane extension behind the back-plate and into local intraocular structures may contribute to significant morbidity. Indeed, recent reports of RPM-related sequelae include sterile keratolysis and K-Pro extrusion, angle closure and glaucoma development, and, in some cases, tractional retinal detachments.

Summary

RPM formation after K-Pro implantation compromises the stability of the device and long-term patient outcomes. Accordingly, further investigations are needed to understand RPM etiology in order to inform the development of more effective strategies for prophylaxis and treatment.

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
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

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

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

    Article  PubMed  Google Scholar 

  2. Khan BF, et al. The Boston keratoprosthesis in herpetic keratitis. Arch Ophthalmol. 2007;125(6):745–9.

    Article  PubMed  Google Scholar 

  3. Akpek EK, et al. Outcomes of Boston keratoprosthesis in aniridia: a retrospective multicenter study. Am J Ophthalmol. 2007;144(2):227–31.

    Article  PubMed  Google Scholar 

  4. Aquavella JV, et al. Pediatric keratoprosthesis. Ophthalmology. 2007;114(5):989–94.

    Article  PubMed  Google Scholar 

  5. •• Lee WB, et al. Boston keratoprosthesis: outcomes and complications: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(7):1504–11. Recent review article that compiles all published series of more than 25 eyes with implanted Boston type 1 keratoprosthesis.

  6. Ament JD, et al. Cost-effectiveness of the Boston keratoprosthesis. Am J Ophthalmol. 2010;149(2):221.e2–8.e2.

    Article  Google Scholar 

  7. Dohlman CH, 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 

  8. Khan BF, 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 

  9. • Harissi-Dagher M, et al. Importance of nutrition to corneal grafts when used as a carrier of the Boston keratoprosthesis. Cornea. 2007;26(5):564–8. This article introduces the concept that the carrier corneal graft depends on nutrition from the aqueous humor and thus the device is modified to incorporate holes in the back plate.

  10. Hicks CR, Hamilton S. Retroprosthetic membranes in AlphaCor patients: risk factors and prevention. Cornea. 2005;24(6):692–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Patel AP, et al. Boston type 1 keratoprosthesis: the New York eye and ear experience. Eye (Lond). 2012;26(3):418–25.

    Article  CAS  Google Scholar 

  13. Robert MC, Biernacki K, Harissi-Dagher M. Boston keratoprosthesis type 1 surgery: use of frozen versus fresh corneal donor carriers. Cornea. 2012;31(4):339–45.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. •• Rudnisky CJ, et al. Risk factors for the development of retroprosthetic membranes with Boston keratoprosthesis type 1: multicenter study results. Ophthalmology. 2012;119(5):951–5. Only study to date that found statistically significant risk factors for the development of retroprosthetic membranes.

  17. • Stacy RC, et al. Characterization of retrokeratoprosthetic membranes in the Boston type 1 keratoprosthesis. Arch Ophthalmol. 2011;129(3):310–6. First histopathological study suggesting stromal downgrowth as the source of membrane formation.

  18. • Hou JH, et al. Histopathological and immunohistochemical analysis of melt-associated retroprosthetic membranes in the Boston type 1 keratoprosthesis. JAMA Ophthalmol. 2014;132(9):1133–6. First histopathological study in melt patients that showed heterogenicity in RPM composition.

  19. Dudenhoefer EJ, et al. Histopathology of explanted collar button keratoprostheses: a clinicopathologic correlation. Cornea. 2003;22(5):424–8.

    Article  CAS  PubMed  Google Scholar 

  20. Duan D, Klenkler BJ, Sheardown H. Progress in the development of a corneal replacement: keratoprostheses and tissue-engineered corneas. Expert Rev Med Devices. 2006;3(1):59–72.

    Article  CAS  PubMed  Google Scholar 

  21. Kim MK, et al. Effect of poly(ethylene glycol) graft polymerization of poly(methyl methacrylate) on cell adhesion. In vitro and in vivo study. J Cataract Refract Surg. 2001;27(5):766–74.

    Article  CAS  PubMed  Google Scholar 

  22. Gilbert AL, et al. A comparison of retrokeratoprosthetic membrane and conjunctival inflammatory responses to silicone oil. J Ophthalmic Inflamm Infect. 2014;4:15.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lifshitz T, Oshry T, Rosenthal G. Retrocorneal membrane after penetrating keratoplasty. Ophthalmic Surg Lasers. 2001;32(2):159–61.

    CAS  PubMed  Google Scholar 

  24. Huang Y, et al. Moscow eye microsurgery complex in Russia keratoprosthesis in Beijing. Ophthalmology. 2011;118(1):41–6.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  26. Chak G, Aquavella JV. A safe Nd:YAG retroprosthetic membrane removal technique for keratoprosthesis. Cornea. 2010;29(10):1169–72.

    Article  PubMed  Google Scholar 

  27. Shapiro BL, et al. High-resolution spectral domain anterior segment optical coherence tomography in type 1 Boston keratoprosthesis. Cornea. 2013;32(7):951–5.

    Article  PubMed  PubMed Central  Google Scholar 

  28. • Sivaraman KR, et al. Retroprosthetic membrane and risk of sterile keratolysis in patients with type I Boston keratoprosthesis. Am J Ophthalmol. 2013;155(5): 814–22. Study demonstrating RPM is associated with sterile corneal melt.

  29. Modjtahedi BS, Eliott D. Vitreoretinal complications of the Boston keratoprosthesis. Semin Ophthalmol. 2014;29(5–6):338–48.

    Article  PubMed  Google Scholar 

  30. Zerbe BL, et al. Results from the multicenter Boston type 1 keratoprosthesis study. Ophthalmology. 2006;113(10):1779.e1–e7.

    Article  Google Scholar 

  31. Dohlman CH, et al. Introduction to the use of the Boston keratoprosthesis. Expert Rev Ophthalmol. 2006;1(1):41–8.

    Article  Google Scholar 

  32. Ray S, et al. Management of vitreoretinal complications in eyes with permanent keratoprosthesis. Arch Ophthalmol. 2002;120(5):559–66.

    Article  PubMed  Google Scholar 

  33. Goldman DR, et al. Postoperative posterior segment complications in eyes treated with the Boston type I keratoprosthesis. Retina. 2013;33(3):532–41.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  35. • Todani A, et al. Titanium back plate for a PMMA keratoprosthesis: clinical outcomes. Graefes Arch Clin Exp Ophthalmol. 2011;249(10):1515–8. Preliminary results showing decreased frequency of RPM in titanium back plate models.

  36. Kiang L, et al. Vitreoretinal surgery in the setting of permanent keratoprosthesis. Arch Ophthalmol. 2012;130(4):487–92.

    Article  PubMed  Google Scholar 

  37. Wang Q, Harissi-Dagher M. Characteristics and management of patients with Boston type 1 keratoprosthesis explantation—the University of Montreal Hospital Center experience. Am J Ophthalmol. 2014;158(6):1297.e1–304.e1.

    Google Scholar 

  38. Garcia JP Jr, et al. Imaging implanted keratoprostheses with anterior-segment optical coherence tomography and ultrasound biomicroscopy. Cornea. 2008;27(2):180–8.

    Article  PubMed  Google Scholar 

  39. Panarelli JF, et al. Angle closure after Boston keratoprosthesis. J Glaucoma. 2013;22(9):725–9.

    Article  PubMed  Google Scholar 

  40. Dokey A, et al. Chronic hypotony associated with the Boston type 1 keratoprosthesis. Am J Ophthalmol. 2012;154(2):266.e1–71.e1.

    Article  Google Scholar 

  41. Bielory BP, et al. Epithelial downgrowth after type 1 Boston keratoprosthesis manifesting as tractional retinal detachment and epiretinal membrane. Arch Ophthalmol. 2012;130(1):118–20.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 West Taylor Street, M/C 648, Chicago, IL, 60612, USA

    Zeeshan Haq & Maria S. Cortina

Authors
  1. Zeeshan Haq
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria S. Cortina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria S. Cortina.

Ethics declarations

Disclosure

Zeeshan Haq and Maria Cortina declare that they have 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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haq, Z., Cortina, M.S. Retroprosthetic Membrane Formation After Boston Keratoprosthesis: Is It Truly a Benign Complication?. Curr Ophthalmol Rep 4, 116–123 (2016). https://doi.org/10.1007/s40135-016-0101-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40135-016-0101-4

Keywords

Search

Navigation