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The treatment of end-stage corneal disease: penetrating keratoplasty compared with Boston type 1 keratoprosthesis

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Abstract

Penetrating keratoplasty (PKP) yields excellent results for restoring vision in end-stage corneal diseases. However, its success is limited to high-risk diseases such as aniridia, chemical burns, autoimmune corneal diseases, and herpetic eye disease. Boston type 1 keratoprosthesis (BKPro) offers another option to these patients. Since 1992, improvements in perioperative management and device construction have significantly increased the use of BKPro worldwide and challenged the therapeutic role of PKP in these patients. This review aims to evaluate BKPro’s place in the treatment algorithm of these high-risk patients to assist surgeons’ decision-making. PKP and BKPro are compared in three outcome categories: visual acuity, graft retention and failure, and complications profile. Special attention is given to comparing secondary BKPro versus repeated PKP as well as primary BKPro versus primary PKP. We conclude that secondary BKPro bears a better prognosis than repeated PKP in most high-risk patients. Similarly, primary BKPro likely confers improved outcomes over primary PKP in most high-risk recipients. However, current evidence is based on retrospective designs, and controlled prospective randomized trials are required to validate these conclusions.

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Authors and Affiliations

  1. Université de Montréal, 1000 St-Denis, Montreal, QC, H2X 0C1, Canada

    Steven Bonneau, C. Maya Tong, Yelin Yang & Mona Harissi-Dagher

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  1. Steven Bonneau
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  2. C. Maya Tong
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  3. Yelin Yang
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  4. Mona Harissi-Dagher
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Contributions

SB performed literature research and manuscript redaction. MT and YY assisted SB in literature research and provided clinical insights, and they helped with manuscript redaction. MHD is the PI of this review and the principal supervisor of SB, MT, and YY. MHD also provided clinical insights and helped with manuscript redaction. All authors read and approved the final manuscript.

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Correspondence to Steven Bonneau.

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M. Harissi-Dagher and C. Maya Tong are advisors for Dompe regarding cenegermin in the treatment of neurotrophic keratitis.

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Bonneau, S., Tong, C.M., Yang, Y. et al. The treatment of end-stage corneal disease: penetrating keratoplasty compared with Boston type 1 keratoprosthesis. Graefes Arch Clin Exp Ophthalmol 260, 2781–2790 (2022). https://doi.org/10.1007/s00417-022-05646-1

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