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Long-term outcomes of the aphakic snap-on Boston type I keratoprosthesis at the Bascom Palmer Eye Institute

Authors Gibbons A, Leung EH, Haddock LJ, Medina CA, Fernandez V, Parel JMA, Durkee HA, Amescua G, Alfonso EC, Perez VL

Received 20 June 2017

Accepted for publication 30 August 2017

Published 15 February 2018 Volume 2018:12 Pages 331—337

DOI https://doi.org/10.2147/OPTH.S144403

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser


Allister Gibbons,1 Ella H Leung,1 Luis J Haddock,1 Carlos A Medina,1 Viviana Fernandez,2 Jean-Marie A Parel,1,2 Heather A Durkee,2 Guillermo Amescua,1 Eduardo C Alfonso,1 Victor L Perez1,3

1Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL, 2Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 3Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA

Purpose: To determine the indications, long-term clinical and visual outcomes, and complications of the aphakic snap-on type I Boston keratoprosthesis (KPro).
Design: Retrospective, non-comparative case series.
Methods: Forty-five eyes of 43 patients with type I aphakic snap-on KPros with at least 1 year of follow-up were included. The past medical histories, preoperative indications, best-corrected visual acuities (BCVAs), postoperative complications, and retention rates were analyzed.
Results: The most common indication for KPro implantation was a failed corneal graft (89%). The mean preoperative BCVA was count fingers–hand motion (2.14±0.45 logarithm of minimum angle of resolution [logMAR]), which initially improved to 20/200 (1.04±0.85 logMAR; P<0.0001). At the last examination, 24 eyes (53%) maintained some visual gain, 22% retained their preoperative visual acuity, and 24% lost vision due to postoperative events and underlying ocular comorbidities. Postoperative complications included retroprosthetic membranes (8/45, 18%), corneal melts (5/45, 11%), glaucoma progression (6/45, 13%), and endophthalmitis or sterile vitritis (6/45, 13%). The KPro retention rate was 89%, with a mean follow-up of 51 months. The mean BCVA at the last visit was 20/1,400 (1.82±0.92 logMAR).
Conclusion: Most patients experienced improved visual acuity after the implantation of the aphakic, snap-on type I KPro; however, the visual gains were not sustained over time, correlating with the onset of postoperative complications.

Keywords: keratoprosthesis, corneal blindness, aphakia, penetrating keratoplasty, snap-on type I keratoprosthesis

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