Ten-Year Outcome of Boston Type I Keratoprosthesis Surgery at a Tertiary Care Center

Purpose:The aim of this study was to report long-term outcomes of patients who have undergone Boston type I keratoprosthesis (KPro) surgery.Methods:This study was a retrospective review. Inclusion criteria were KPro surgery between 2006 and 2012 and at least 10 years of follow-up. Demographics, ocular history, surgery indication, clinical variables, and postsurgical outcomes were recorded. Descriptive statistical analysis was performed.Results:We identified 75 patients with KPro implantation, and 17 patients with at least 10 years of follow-up (median = 11.1 years; range, 10.0-12.8 years) were included. Of 17 eyes, 11 (64.8%) had their original device in situ, 3 (17.6%) had their second device in situ, 1 (5.9%) had the device removed and replaced with a donor keratoplasty, and 2 (11.8%) were enucleated. At the last follow-up, 11 eyes (64.7%) were able to maintain improvement in vision, 5 (29.4%) had worsened vision, 1 (5.9%) had stable vision, and 9 (52.9%) had visual acuity <Snellen 20/200. Major complications included infectious keratitis (n = 5, 29.4%), hypotony (n = 4, 23.5%), retinal detachment (n = 4, 23.5%), endophthalmitis (n = 2, 11.8%), and retroprosthetic membrane (n = 7, 50%). In addition, 15 eyes (88.2%) required glaucoma surgery. All but 1 eye lost best-ever visual acuity with 9 eyes (52.9%) because of glaucoma progression.Conclusions:KPro had an acceptable retention proportion and remains a viable option for eyes at high risk of failure with donor keratoplasty. However, subsequent surgeries are commonly performed postoperatively to manage complications. Glaucoma seems to be the main etiology of irreversible vision loss.