Skip to main content
SpringerLink
Log in

Indications and Contraindications of Boston KPRO Types I and II

  • Chapter
  • First Online:
Keratoprostheses and Artificial Corneas

Abstract

With advances in microsurgical techniques and postoperative management, standard keratoplasty and ocular surface reconstruction have become increasingly successful in the visual rehabilitation of patients with corneal blindness. However, there remains patients for whom such procedures carry a very poor prognosis. This includes patients with autoimmune and cicatricial diseases, limbal stem cell deficiency, or multiple failed grafts. The Boston Keratoprosthesis (KPro) is recognized as a viable alternative for such patients. Tremendous improvements in the visual outcomes, complication rates, and device retention rates have been achieved in the last decades. With continued innovation and the diligent involvement of multiple surgeons and researchers, the KPro is now recognized as a safe and reasonable approach in the management of a variety of causes of corneal blindness. This chapter focuses on the traditional indications for KPro as well as the promising new applications appearing in the recent literature.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AH:

Aqueous humor

APECED:

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy

BSA:

Body surface area

CF:

Counting fingers

FDA:

Food and Drug Administration

HM:

Hand motion

HSV:

Herpes simplex virus

IOL:

Intraocular lens

IOP:

Intraocular pressure

KPro:

Boston Keratoprosthesis

LP:

Light perception

LSC:

Limbal stem cell

LSCD:

Limbal stem cell deficiency

LSCT:

Limbal stem cell transplantation

MMP:

Mucous membrane pemphigoid

MMPO:

MMP with ocular involvement

OCP:

Ocular cicatricial pemphigoid

PED:

Persistent epithelial defect

PKP:

Penetrating keratoplasty

PMMA:

Polymethyl methacrylate

PPV:

Pars plana vitrectomy

RPM:

Retroprosthetic membrane

SI:

Systemic immunosuppression

SJS:

Stevens-Johnson syndrome

SO:

Silicone oil

TEN:

Toxic epidermal necrolysis

VA:

Visual acuity

VZV:

Varicella zoster virus herpes zoster virus

References

  1. Walcott-Harris R, Chodosh J, Dohlman C. CE Mark will make KPro available in Europe. Boston KPro News. 2011;fall(8). Available at http://www.masseyeandear.org.

  2. Harissi-Dagher M, Beyer J, Dohlman CH. The role of soft contact lenses as an adjunct to the Boston keratoprosthesis. Int Ophthalmol Clin. 2008;48(2):43–51.

    Article  PubMed  Google Scholar 

  3. Kang J, de la Cruz J, Cortina M. Visual outcomes of Boston keratoprosthesis implantation as the primary penetrating corneal procedure. Cornea. 2012;31(12):1436–40.

    Article  PubMed  Google Scholar 

  4. Dohlman C, Dudenhoefer E, Khan B, Morneault S. Protection of the ocular surface after keratoprosthesis surgery: the role of soft contact lenses. CLAO J. 2002;28(2):72–4.

    PubMed  Google Scholar 

  5. Harissi-Dagher M, Khan B, Schaumberg D, Dohlman C. Importance of nutrition to corneal grafts when used as a carrier of the Boston keratoprosthesis. Cornea. 2007;26(5):564–8.

    PubMed  Google Scholar 

  6. Durand M, Dohlman C. Successful prevention of bacterial endophthalmitis in eyes with the Boston keratoprosthesis. Cornea. 2009;28(8):896–901.

    Article  PubMed  Google Scholar 

  7. Dohlman C, Harissi-Dagher M. The Boston keratoprosthesis: a new threadless design. Digit J Ophthalmol. 2007;13(3). Available at http://www.djo.harvard.edu/site.php?url=/physicians/oa/1055

  8. Traish AS, Chodosh J. Expanding application of the Boston type I keratoprosthesis due to advances in design and improved post-operative therapeutic strategies. Semin Ophthalmol. 2010;25(5–6):239–43.

    Article  PubMed  Google Scholar 

  9. Todani A, Ciolino JB, Ament JD, Colby KA, Pineda R, Belin MW, et al. Titanium back plate for a PMMA keratoprosthesis: clinical outcomes. Graefes Arch Clin Exp Ophthalmol. 2011;249(10):1515–8.

    Article  CAS  PubMed  Google Scholar 

  10. Yaghouti F, Nouri M, Abad JC, Power WJ, Doane MG, Dohlman CH. Keratoprosthesis: preoperative prognostic categories. Cornea. 2001;20(1):19–23.

    Article  CAS  PubMed  Google Scholar 

  11. Cade F, Grosskreutz C, Tauber A, Dohlman C. Glaucoma in eyes with severe chemical burn, before and after keratoprosthesis. Cornea. 2011;30(12):1322–7.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Gueudry J, Roujeau J, Binaghi M, Soubrane G, Muraine M. Risk factors for the development of ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Arch Dermatol. 2009;145(2):157–62.

    Article  PubMed  Google Scholar 

  14. Morales M, Purdue G, Verity S, Arnoldo B, Blomquist P. Ophthalmic manifestations of Stevens-Johnson Syndrome and toxic epidermal necrolysis and relation to SCORTEN. Am J Ophthalmol. 2010;150(4):505–10.

    Article  PubMed  Google Scholar 

  15. Power W, Ghoraishi M, Merayo-Lloves J, Neves R, Foster C. Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum. Ophthalmology. 1995;102(11):1669–76.

    Article  CAS  PubMed  Google Scholar 

  16. Chang Y, Huang F, Tseng S, Hsu C, Ho C, Sheu H. Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis: acute ocular manifestations, causes, and management. Cornea. 2007;26(2):123–9.

    Article  PubMed  Google Scholar 

  17. Sotozono C, Ang L, Koizumi N, Higashihara H, Ueta M, Inatomi T, et al. New grading system for the evaluation of chronic ocular manifestations in patients with Stevens-Johnson syndrome. Ophthalmology. 2007;114(7):1294–302.

    Article  PubMed  Google Scholar 

  18. Sayegh R, Ang L, Foster C, Dohlman C. The Boston keratoprosthesis in Stevens-Johnson syndrome. Am J Ophthalmol. 2008;145(3):438–44.

    Article  PubMed  Google Scholar 

  19. Chan L, Ahmed A, Anhalt G, Bernauer W, Cooper K, Elder M, et al. The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators. Arch Dermatol. 2002;138(3):370–9.

    Article  PubMed  Google Scholar 

  20. Kirzhner M, Jakobiec F. Ocular cicatricial pemphigoid: a review of clinical features, immunopathology, differential diagnosis, and current management. Semin Ophthalmol. 2011;26(4–5):270–7.

    Article  PubMed  Google Scholar 

  21. Ahmed M, Zein G, Khawaja F, Foster C. Ocular cicatricial pemphigoid: pathogenesis, diagnosis and treatment. Prog Retin Eye Res. 2004;23(6):579–92.

    Article  PubMed  Google Scholar 

  22. Dohlman C, Terada H. Keratoprosthesis in pemphigoid and Stevens-Johnson syndrome. Adv Exp Med Biol. 1998;438:1021–5.

    Article  CAS  PubMed  Google Scholar 

  23. Pujari S, Siddique S, Dohlman C, Chodosh J. The Boston keratoprosthesis type II: the Massachusetts Eye and Ear Infirmary experience. Cornea. 2011;30(12):1298–303.

    Article  PubMed  Google Scholar 

  24. Harissi-Dagher M, Dohlman C. The Boston keratoprosthesis in severe ocular trauma. Can J Ophthalmol. 2008;43(2):165–9.

    Article  PubMed  Google Scholar 

  25. Al-Mezaine H, Wagoner MD, King Khaled Eye Specialist Hospital Cornea Transplant Study Group. Repeat penetrating keratoplasty: indications, graft survival, and visual outcome. Br J Ophthalmol. 2006;90(3):324–7.

    Google Scholar 

  26. Weisbrod D, Sit M, Naor J, Slomovic A. Outcomes of repeat penetrating keratoplasty and risk factors for graft failure. Cornea. 2003;22(5):429–34.

    Article  PubMed  Google Scholar 

  27. Beckingsale P, Mavrikakis I, Al-Yousuf N, Mavrikakis E, Daya S. Penetrating keratoplasty: outcomes from a corneal unit compared to national data. Br J Ophthalmol. 2006;90(6):728–31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Bersudsky V, Blum-Hareuveni T, Rehany U, Rumelt S. The profile of repeated corneal transplantation. Ophthalmology. 2001;108(3):461–9.

    Article  CAS  PubMed  Google Scholar 

  29. Thompson RJ, Price M, Bowers P, Price FJ. Long-term graft survival after penetrating keratoplasty. Ophthalmology. 2003;110(7):1396–402.

    Article  PubMed  Google Scholar 

  30. Yildiz E, Hoskins E, Fram N, Rapuano C, Hammersmith K, Laibson P, et al. Third or greater penetrating keratoplasties: indications, survival, and visual outcomes. Cornea. 2010;29(3):254–9.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  32. 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(4):687–92.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  34. 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 

  35. Patel A, Wu E, Ritterband D, Seedor J. Boston type 1 keratoprosthesis: the New York Eye and Ear experience. Eye. 2012;26(3):418–25.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Chew HF, Ayres BD, Hammersmith KM, Rapuano CJ, Laibson PR, Myers JS, et al. Boston keratoprosthesis outcomes and complications. Cornea. 2009;28:989–96.

    Article  PubMed  Google Scholar 

  37. Espana E, Di Pascuale M, Grueterich M, Solomon A, Tseng S. Keratolimbal allograft in corneal reconstruction. Eye. 2004;18(4):406–17.

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  39. Basu S, Taneja M, Narayanan R, Senthill S, Sangwan V. Short-term outcome of Boston type 1 keratoprosthesis for bilateral limbal stem cell deficiency. Indian J Ophthalmol. 2012;60(2):151–3.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Biber J, Skeens H, Neff K, Holland E. The Cincinnati procedure: technique and outcomes of combines living-related conjunctival allografts and keratolimbal allografts in severe ocular surface failure. Cornea. 2011;30(7):765–71.

    Article  PubMed  Google Scholar 

  41. Hou J, Cruz J, Djalilian A. Outcomes of Boston keratoprosthesis implantation for failed keratoplasty after keratolimbal allograft. Cornea. 2012;31(12):1432–5.

    Article  PubMed  Google Scholar 

  42. Chan C, Biber J, Holland E. The modified Cincinnati procedure: combined conjunctival limbal autografts and keratolimbal allografts for severe unilateral ocular surface failure. Cornea. 2012;31(11):1264–72.

    Article  PubMed  Google Scholar 

  43. Ang A, Chan C, Biber J, Holland E. Ocular surface stem cell transplantation rejection: incidence, characteristics, and outcomes. Cornea. 2013;32(3):229–36.

    Article  PubMed  Google Scholar 

  44. Akpek EK, Harissi-Dagher M, Petrarca R, Butrus SI, Pineda RI, Aquavella JV, et al. Outcomes of Boston keratoprosthesis in aniridia: a retrospective multicenter study. Am J Ophthalmol. 2007;144(2):227–31.e1.

    Article  PubMed  Google Scholar 

  45. de la Paz M, Alvarez de Toledo J, Barraquer R. Long-term visual prognosis of corneal and ocular surface surgery in patients with congenital aniridia. Acta Ophthalmol. 2008;86(7):735–40.

    Article  PubMed  Google Scholar 

  46. Tsai J, Freeman J, Chan C, Schwartz G, Derby E, Petersen M, et al. A progressive anterior fibrosis syndrome in patients with postsurgical congenital aniridia. Am J Ophthalmol. 2005;140(6):1075–9.

    Article  PubMed  Google Scholar 

  47. Bakhtiari P, Chan C, Welder J, de la Cruz J, Holland E, Djalilian A. 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(5):967–71.

    Article  PubMed  Google Scholar 

  48. Basu S, Taneja M, Sangwan V. Boston type 1 keratoprosthesis for severe blinding vernal keratoconjunctivitis and Mooren’s ulcer. Int Ophthalmol. 2011;31(3):219–22.

    Article  PubMed  Google Scholar 

  49. Dutta J, Mukhopadhyay S, Datta H, Sen S. Boston keratoprosthesis restoring vision in an unusual case of end-stage limbal stem cell deficiency following exposure to Euphorbia latex. Int Ophthalmol. 2012;32(1):77–9.

    Article  PubMed  Google Scholar 

  50. Yildiz E, Saad C, Eagle R, Ayres B, Cohen E. The Boston keratoprosthesis in 2 patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. Cornea. 2010;29(3):354–6.

    Article  PubMed  Google Scholar 

  51. Cobo L, Coster D, Rice N, Jones B. Prognosis and management of corneal transplantation for herpetic keratitis. Arch Ophthalmol. 1980;98(10):1755–9.

    Article  CAS  PubMed  Google Scholar 

  52. Garcia D, Shtein R, Musch D, Elner V. Herpes simplex virus keratitis: histopathologic neovascularization and corneal allograft failure. Cornea. 2009;28(9):963–5.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Garcia D, Farjo Q, Musch D, Sugar A. Effect of prophylactic oral acyclovir after penetrating keratoplasty. Cornea. 2007;26(8):930–4.

    Article  PubMed  Google Scholar 

  54. Pavan-Langston D, Dohlman C. Boston keratoprosthesis treatment of herpes zoster neurotrophic keratopathy. Ophthalmology. 2008;115(2):S21–3.

    Article  PubMed  Google Scholar 

  55. Khan B, Harissi-Dagher M, Pavan-Langston D, Aquavella J, Dohlman C. The Boston keratoprosthesis in herpetic keratitis. Arch Ophthalmol. 2007;125(6):745–9.

    Article  PubMed  Google Scholar 

  56. Shimazaki J, Hida T, Inoue M, Saito H, Tsubota K. Long-term follow-up of patients with familial subepithelial amyloidosis of the cornea. Ophthalmology. 1995;102(1):139–44.

    Article  CAS  PubMed  Google Scholar 

  57. Cortina M, Porter I, Sugar J, de la Cruz J. Boston type I keratoprosthesis for visual rehabilitation in a patient with gelatinous drop-like corneal dystrophy. Cornea. 2012;31(7):844–5.

    Article  PubMed  Google Scholar 

  58. Dohlman C, D’Amico D. Can an eye in phthisis be rehabilitated? A case of improved vision with 1-year follow-up. Arch Ophthalmol. 1999;117(1):123–4.

    Article  CAS  PubMed  Google Scholar 

  59. Utine C, Gehlbach P, Zimmer-Galler I, Akpek E. Permanent keratoprosthesis combined with pars plana vitrectomy and silicone oil injection for visual rehabilitation of chronic hypotony and corneal opacity. Cornea. 2010;29(12):1401–5.

    Article  PubMed  Google Scholar 

  60. Iyer G, Srinivasan B, Gupta J, Rishi P, Sen P, Bhende P, et al. Boston keratoprosthesis for keratopathy in eyes with retained silicone oil: a new indication. Cornea. 2011;30(10):1083–7.

    Article  PubMed  Google Scholar 

  61. Chan C, Holland E, Sawyer W, Neff K, Petersen M, Riemann C. Boston type 1 keratoprosthesis combined with silicone oil for treatment of hypotony in prephthisical eyes. Cornea. 2012;30(10):1105–9.

    Article  Google Scholar 

  62. Vanathi M, Panda A, Vengayll S, Chaudhuri Z, Dada T. Pediatric keratoplasty. Surv Ophthalmol. 2009;54(2):245–71.

    Article  CAS  PubMed  Google Scholar 

  63. Botelho P, Congdon N, Handa J, Akpek E. Keratoprosthesis in high-risk pediatric corneal transplantation: first 2 cases. Arch Ophthalmol. 2006;124(9):1356–7.

    Article  PubMed  Google Scholar 

  64. Nallasamy S, Colby K. Keratoprosthesis: procedure of choice for corneal opacities in children. Semin Ophthalmol. 2010;25(5–6):244–8.

    Article  PubMed  Google Scholar 

  65. Aquavella J, Gearinger M, Akpek E, McCormick G. Pediatric keratoprosthesis. Ophthalmology. 2007;114(5):989–94.

    Article  PubMed  Google Scholar 

  66. Aquavella J. Pediatric keratoprosthesis: a new surgical approach. Ann Ophthalmol. 2008;40(2):64–7.

    Google Scholar 

  67. Srinivasan B, Choudhari N, Neog A, Latka S, Iyer G. Boston keratoprosthesis and Ahmed glaucoma valve for visual rehabilitation in congenital anterior staphyloma. Indian J Ophthalmol. 2012;60(3):232–3.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Sayegh R, Avena Diaz L, Vargas-Martin F, Webb R, Dohlman C, Peli E. Optical functional properties of the Boston keratoprosthesis. Invest Ophthalmol Vis Sci. 2010;51(2):857–63.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Pineles S, Ela-Dalman N, Rosenbaum A, Aldave A, Velez F. Binocular visual function in patients with Boston type I keratoprosthesis. Cornea. 2010;29(12):1397–400.

    Article  PubMed  Google Scholar 

  70. Rahi J, Cumberland P, Peckham C. Visual impairment and vision-related quality of life in working-age adults: findings in the 1958 British birth cohort. Ophthalmology. 2009;116(2):270–4.

    Article  PubMed  Google Scholar 

  71. O’Connor A, Birch E, Anderson S, Draper H, Group FR. The functional significance of stereopsis. Invest Ophthalmol Vis Sci. 2010;2010(51):4.

    Google Scholar 

  72. Whitcher J, Srinivasan M, Upadhyay M. Corneal blindness: a global perspective. Bull World Health Organ. 2001;79(3):214–21.

    CAS  PubMed Central  PubMed  Google Scholar 

  73. Oliveira L, Cade F, Dohlman C. Keratoprosthesis in the fight against corneal blindness in developing countries. Arq Bras Oftalmol. 2011;74(1):5–6.

    PubMed  Google Scholar 

  74. Ament J, Stryjewksi T, Ciolino J, Todani A, Chodosh J, Dohlman C. Cost-effectiveness of the Boston keratoprosthesis. Am J Ophthalmol. 2010;149(2):221–8.

    Article  PubMed  Google Scholar 

  75. Ament J, Tilahun Y, Mudawi E, Pineda R. Role for ipsilateral autologous corneas as a carrier for the Boston keratoprosthesis: the Africa experience. Arch Ophthalmol. 2010;128(6):795–7.

    Article  PubMed  Google Scholar 

  76. Robert M, 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 

  77. Akpek E, Aldave A, Aquavella J. The use of precut, γ-irradiated corneal lenticules in Boston type 1 keratoprosthesis implantation. Am J Ophthalmol. 2012;154(3):495–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  79. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  80. Aldave A, Sangwan V, Basu S, Basak S, Hovakimyan A, Gevorgyan O, et al. International results with the Boston Type I Keratoprosthesis. Ophthalmology. 2012;119(8):1530–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Centre Hospitalier de l’Université de Montréal (CHUM), Hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, QC, H2L 4M1, Canada

    Marie-Claude Robert MD & Mona Harissi-Dagher MD

Authors
  1. Marie-Claude Robert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mona Harissi-Dagher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie-Claude Robert MD .

Editor information

Editors and Affiliations

  1. Cornea, External Disease and Refractive Surgery, Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, Illinois, USA

    M. Soledad Cortina

  2. Cornea, External Disease and Refractive Surgery, Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, Illinois, USA

    Jose de la Cruz

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Robert, MC., Harissi-Dagher, M. (2015). Indications and Contraindications of Boston KPRO Types I and II. In: Cortina, M., de la Cruz, J. (eds) Keratoprostheses and Artificial Corneas. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-55179-6_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-55179-6_7

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-55178-9

  • Online ISBN: 978-3-642-55179-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation