Boston KPro Type I in the Pediatric Age Group

  • Sang Beom Han
  • Karen Dunlap
  • Esen Karamursel Akpek
Chapter

Abstract

Corneal opacity in pediatric patients may be congenital or acquired. Significant corneal opacities in infants can lead to profound deprivation amblyopia. For this reason, early surgical intervention to provide a clear visual axis is recommended. Surgery usually involves a full thickness penetrating keratoplasty (PK). Although PK results are excellent in most adult patients, pediatric cases are not as successful due to the technical difficulty of this surgery, higher rates of graft failure from allograft rejection, and challenges in postoperative visual rehabilitation.

The Boston type 1 keratoprosthesis (KPro), once considered a last resort in patients with multiple PK failures, is now considered a reasonable alternative. It even can be the first-line option for cases known to be at high risk for failure with traditional donor corneal transplantation. Thus far, studies of adult patients have shown favorable outcomes with the KPro, with rapid visual recovery and excellent retention rates. KPro may also be useful in the treatment of pediatric corneal opacity as it can restore a clear visual axis quickly and thus may be useful in amblyopia prevention. It does not opacify and cannot be rejected. In addition, the built in refractive rehabilitation even in aphakic patients is advantageous, particularly in pediatric cases. Initial reports from a few centers demonstrate encouraging results from pediatric KPro surgeries.

Keywords

Titanium Hydration Retina Nylon Glaucoma 

References

  1. 1.
    Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a global perspective. Bull World Health Organ. 2001;79:214–21.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Rezende RA, Uchoa UB, Uchoa R, Rapuano CJ, Laibson PR, Cohen EJ. Congenital corneal opacities in a cornea referral practice. Cornea. 2004;23:565–70.PubMedCrossRefGoogle Scholar
  3. 3.
    Aquavella JV. Pediatric keratoprosthesis: a new surgical approach. Ann Ophthalmol (Skokie). 2008;40:64–7.Google Scholar
  4. 4.
    Botelho PJ, Congdon NG, Handa JT, Akpek EK. Keratoprosthesis in high-risk pediatric corneal transplantation: first 2 cases. Arch Ophthalmol. 2006;124:1356–7.PubMedCrossRefGoogle Scholar
  5. 5.
    McClellan K, Lai T, Grigg J, Billson F. Penetrating keratoplasty in children: visual and graft outcome. Br J Ophthalmol. 2003;87:1212–4.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Comer RM, Daya SM, O’Keefe M. Penetrating keratoplasty in infants. J AAPOS. 2001;5:285–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Aasuri MK, Garg P, Gokhle N, Gupta S. Penetrating keratoplasty in children. Cornea. 2000;19:140–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Vanathi M, Panda A, Vengayil S, Chaudhuri Z, Dada T. Pediatric keratoplasty. Surv Ophthalmol. 2009;54:245–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Williams KA, Muehlberg SM, Lewis RF, Coster DJ. How successful is corneal transplantation? A report from the Australian Corneal Graft Register. Eye (Lond). 1995;9(Pt 2):219–27.CrossRefGoogle Scholar
  10. 10.
    Nallasamy S, Colby K. Keratoprosthesis: procedure of choice for corneal opacities in children? Semin Ophthalmol. 2010;25:244–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Dana MR, Moyes AL, Gomes JA, et al. The indications for and outcome in pediatric keratoplasty. A multicenter study. Ophthalmology. 1995;102:1129–38.PubMedCrossRefGoogle Scholar
  12. 12.
    Sharma N, Prakash G, Titiyal JS, Tandon R, Vajpayee RB. Pediatric keratoplasty in India: indications and outcomes. Cornea. 2007;26:810–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Al-Ghamdi A, Al-Rajhi A, Wagoner MD. Primary pediatric keratoplasty: indications, graft survival, and visual outcome. J AAPOS. 2007;11:41–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Dana MR, Schaumberg DA, Moyes AL, Gomes JA. Corneal transplantation in children with Peters anomaly and mesenchymal dysgenesis. Multicenter Pediatric Keratoplasty Study. Ophthalmology. 1997;104:1580–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Aquavella JV, Gearinger MD, Akpek EK, McCormick GJ. Pediatric keratoprosthesis. Ophthalmology. 2007;114:989–94.PubMedCrossRefGoogle Scholar
  16. 16.
    Vajpayee RB, Ray M, Panda A, et al. Risk factors for pediatric presumed microbial keratitis: a case–control study. Cornea. 1999;18:565–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Javadi MA, Baradaran-Rafii AR, Zamani M, et al. Penetrating keratoplasty in young children with congenital hereditary endothelial dystrophy. Cornea. 2003;22:420–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Huang C, O’Hara M, Mannis MJ. Primary pediatric keratoplasty: indications and outcomes. Cornea. 2009;28:1003–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Allan BD, Terry MA, Price Jr FW, Price MO, Griffin NB, Claesson M. Corneal transplant rejection rate and severity after endothelial keratoplasty. Cornea. 2007;26:1039–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Khor WB, Mehta JS, Tan DT. Descemet stripping automated endothelial keratoplasty with a graft insertion device: surgical technique and early clinical results. Am J Ophthalmol. 2011;151:223–32 e2.PubMedCrossRefGoogle Scholar
  21. 21.
    Jeng BH, Marcotty A, Traboulsi EI. Descemet stripping automated endothelial keratoplasty in a 2-year-old child. J AAPOS. 2008;12:317–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Fernandez MM, Buckley EG, Afshari NA. Descemet stripping automated endothelial keratoplasty in a child. J AAPOS. 2008;12:314–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Ponchel C, Malecaze F, Arne JL, Fournie P. Descemet stripping automated endothelial keratoplasty in a child with descemet membrane breaks after forceps delivery. Cornea. 2009;28:338–41.PubMedCrossRefGoogle Scholar
  24. 24.
    Kymionis GD, Kankariya VP, Diakonis VF, Karavitaki AE, Siganos CS, Pallikaris IG. Descemet stripping automated endothelial keratoplasty in a child after failed penetrating keratoplasty. J AAPOS. 2012;16:95–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Colby K. Changing times for pediatric keratoplasty. J AAPOS. 2008;12:223–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Harissi-Dagher M, Dohlman CH. The Boston keratoprosthesis in severe ocular trauma. Can J Ophthalmol. 2008;43:165–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Khan BF, Harissi-Dagher M, Pavan-Langston D, Aquavella JV, Dohlman CH. The Boston keratoprosthesis in herpetic keratitis. Arch Ophthalmol. 2007;125:745–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Pavan-Langston D, Dohlman CH. Boston keratoprosthesis treatment of herpes zoster neurotrophic keratopathy. Ophthalmology. 2008;115:S21–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Akpek EK, Harissi-Dagher M, Petrarca R, et al. Outcomes of Boston keratoprosthesis in aniridia: a retrospective multicenter study. Am J Ophthalmol. 2007;144:227–31.PubMedCrossRefGoogle Scholar
  30. 30.
    Sejpal K, Yu F, Aldave AJ. The Boston keratoprosthesis in the management of corneal limbal stem cell deficiency. Cornea. 2011;30:1187–94.PubMedGoogle Scholar
  31. 31.
    Sayegh RR, Ang LP, Foster CS, Dohlman CH. The Boston keratoprosthesis in Stevens-Johnson syndrome. Am J Ophthalmol. 2008;145:438–44.PubMedCrossRefGoogle Scholar
  32. 32.
    Massachusetts Eye and Ear Infirmary. Boston keratoprosthesis update. Newsletter Fall 2011 (8). Available at: http://www.masseyeandear.org/gedownload!/2011%20KPro%20newsletter.pdf?item_id=70213024.
  33. 33.
    Aquavella JV, Qian Y, McCormick GJ, Palakuru JR. Keratoprosthesis: the Dohlman-Doane device. Am J Ophthalmol. 2005;140:1032–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Aquavella JV, Qian Y, McCormick GJ, Palakuru JR. Keratoprosthesis: current techniques. Cornea. 2006;25:656–62.PubMedCrossRefGoogle Scholar
  35. 35.
    Dohlman CH, Dudenhoefer EJ, Khan BF, Morneault S. Protection of the ocular surface after keratoprosthesis surgery: the role of soft contact lenses. CLAO J. 2002;28:72–4.PubMedGoogle Scholar
  36. 36.
    Dunlap K, Chak G, Aquavella JV, Myrowitz E, Utine CA, Akpek E. Short-term visual outcomes of Boston type 1 keratoprosthesis implantation. Ophthalmology. 2010;117:687–92.PubMedCrossRefGoogle Scholar
  37. 37.
    Aldave AJ, Kamal KM, Vo RC, Yu F. The Boston type I keratoprosthesis: improving outcomes and expanding indications. Ophthalmology. 2009;116:640–51.PubMedCrossRefGoogle Scholar
  38. 38.
    Bakhtiari P, Chan C, Welder JD, de la Cruz J, Holland EJ, Djalilian AR. Surgical and visual outcomes of the type I Boston keratoprosthesis for the management of aniridic fibrosis syndrome in congenital aniridia. Am J Ophthalmol. 2012;153:967–971 e2.PubMedCrossRefGoogle Scholar
  39. 39.
    Bradley JC, Hernandez EG, Schwab IR, Mannis MJ. Boston type 1 keratoprosthesis: the University of California Davis experience. Cornea. 2009;28:321–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Davis EA, Azar DT, Jakobs FM, Stark WJ. Refractive and keratometric results after the triple procedure: experience with early and late suture removal. Ophthalmology. 1998;105:624–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Troutman RC, Gaster RN. Surgical advances and results of keratoconus. Am J Ophthalmol. 1980;90:131–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Lim L, Pesudovs K, Coster DJ. Penetrating keratoplasty for keratoconus: visual outcome and success. Ophthalmology. 2000;107:1125–31.PubMedCrossRefGoogle Scholar
  43. 43.
    Malik TY, McGhee CN. Surgical management of refractive error following penetrating keratoplasty: refining and extending techniques. Clin Experiment Ophthalmol. 2004;32:123–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Kutzscher EM, Sorenson AL, Goodman DF. Penetrating keratoplasty performed by residents. Arch Ophthalmol. 2004;122:1333–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Olson RJ, Pingree M, Ridges R, Lundergan ML, Alldredge Jr C, Clinch TE. Penetrating keratoplasty for keratoconus: a long-term review of results and complications. J Cataract Refract Surg. 2000;26:987–91.PubMedCrossRefGoogle Scholar
  46. 46.
    Dolorico AM, Tayyani R, Ong HV, Gaster RN. Shortterm and long-term visual and astigmatic results of an opposing 10–0 nylon double running suture technique for penetrating keratoplasty. J Am Coll Surg. 2003;197:991–9.PubMedCrossRefGoogle Scholar
  47. 47.
    de Lavalette JG, de Lavalette AR, van Rij G, Beekhuis WH, de Beijer-Dominicus JA. Long-term results of corneal transplantations in keratoconus patients. Doc Ophthalmol. 1985;59:93–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Mascaro VL, Scarpi MJ, Hofling-Lima AL, de Sousa LB. [Corneal transplantation in keratoconus: evaluation of results and complications obtained by skillful and surgeons in training]. Arq Bras Oftalmol. 2007;70:395–405.PubMedCrossRefGoogle Scholar
  49. 49.
    Bahar I, Kaiserman I, Srinivasan S, Ya-Ping J, Slomovic AR, Rootman DS. Comparison of three different techniques of corneal transplantation for keratoconus. Am J Ophthalmol. 2008;146:905–12 e1.PubMedCrossRefGoogle Scholar
  50. 50.
    Hammoudi DS, Segev F, Abdolell M, Rootman DS. Outcome of penetrating keratoplasty performed by cornea fellows compared with that of an experienced staff surgeon. Cornea. 2005;24:410–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Utine CA, Tzu J, Dunlap K, Akpek EK. Visual and clinical outcomes of explantation versus preservation of the intraocular lens during keratoprosthesis implantation. J Cataract Refract Surg. 2011;37:1615–22.PubMedCrossRefGoogle Scholar
  52. 52.
    Pineles SL, Ela-Dalman N, Rosenbaum AL, Aldave AJ, Velez FG. Binocular visual function in patients with Boston type I keratoprostheses. Cornea. 2010;29:1397–400.PubMedCrossRefGoogle Scholar
  53. 53.
    Yaghouti F, Nouri M, Abad JC, Power WJ, Doane MG, Dohlman CH. Keratoprosthesis: preoperative prognostic categories. Cornea. 2001;20:19–23.PubMedCrossRefGoogle Scholar
  54. 54.
    Colby KA, Koo EB. Expanding indications for the Boston keratoprosthesis. Curr Opin Ophthalmol. 2011;22:267–73.PubMedCrossRefGoogle Scholar
  55. 55.
    Rodrigues EB, Farah ME, Maia M, et al. Therapeutic monoclonal antibodies in ophthalmology. Prog Retin Eye Res. 2009;28:117–44.PubMedCrossRefGoogle Scholar
  56. 56.
    Ciolino JB, Dohlman CH. Biologic keratoprosthesis materials. Int Ophthalmol Clin. 2009;49:1–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Ciolino JB, Hoare TR, Iwata NG, et al. A drug-eluting contact lens. Invest Ophthalmol Vis Sci. 2009;50:3346–52.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Sang Beom Han
    • 1
    • 2
  • Karen Dunlap
    • 3
  • Esen Karamursel Akpek
    • 4
  1. 1.The Wilmer Eye InstituteThe Johns Hopkins UniversityBaltimoreUSA
  2. 2.Department of OphthalmologyKangwon National UniversityChuncheonSouth Korea
  3. 3.Department of Ophthalmology, The Wilmer Eye InstituteThe Johns Hopkins HospitalBaltimoreUSA
  4. 4.Cornea and Anterior Segment Service, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations