Boston type 1 keratoprosthesis: The University of California Davis experience

Jay C. Bradley, Enrique Graue Hernandez, Ivan R. Schwab, Mark J Mannis

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

PURPOSE: To compare the University of California Davis experience using the Boston keratoprosthesis with the Boston Keratoprosthesis Study Group's initial report. DESIGN: Retrospective chart review. PARTICIPANTS: We analyzed 30 eyes of 28 patients who previously underwent Boston type 1 keratoprosthesis surgery at our institution between 2004 and 2008. METHODS: Preoperative, intraoperative, and postoperative parameters were collected and analyzed. MAIN OUTCOME MEASURES: Visual acuity and keratoprosthesis stability. RESULTS: Preoperative diagnoses were failed graft (26 eyes, 87%), chemical injury (3 eyes, 10%), and Stevens-Johnson syndrome (1 eye, 3%). Twenty eyes (66%) had preoperative glaucoma. Preoperative best-corrected visual acuity ranged from 20/150 to light perception and was <20/200 in 83% of eyes. At an average follow-up of 19 months (range, 1-48; SD, 13.8; and median, 13), postoperative vision improved to ≥20/200 in 77% of eyes. Among eyes at least 1 year after the operation (16 eyes), vision was ≥20/200 in 75% of eyes and ≥20/40 in 25% of eyes. At an average follow-up of 19 months, retention of the initial keratoprosthesis was 83.3%. CONCLUSIONS: The Boston type 1 keratoprosthesis is a viable option after multiple keratoplasty failures or in conditions with a poor prognosis for primary keratoplasty. Patients with autoimmune disease are at higher risk for complications. The University of California Davis experience seems equivalent to the initial report of the Boston Keratoprosthesis Study Group. With longer follow-up, additional surgical procedures may be required but good anatomic and functional outcomes can be maintained.

Original languageEnglish (US)
Pages (from-to)321-327
Number of pages7
JournalCornea
Volume28
Issue number3
DOIs
StatePublished - Apr 2009

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Corneal Transplantation
Visual Acuity
Eye Injuries
Stevens-Johnson Syndrome
Glaucoma
Autoimmune Diseases
Transplants
Light

Keywords

  • Boston type 1 keratoprosthesis

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Boston type 1 keratoprosthesis : The University of California Davis experience. / Bradley, Jay C.; Hernandez, Enrique Graue; Schwab, Ivan R.; Mannis, Mark J.

In: Cornea, Vol. 28, No. 3, 04.2009, p. 321-327.

Research output: Contribution to journalArticle

Bradley, Jay C. ; Hernandez, Enrique Graue ; Schwab, Ivan R. ; Mannis, Mark J. / Boston type 1 keratoprosthesis : The University of California Davis experience. In: Cornea. 2009 ; Vol. 28, No. 3. pp. 321-327.
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abstract = "PURPOSE: To compare the University of California Davis experience using the Boston keratoprosthesis with the Boston Keratoprosthesis Study Group's initial report. DESIGN: Retrospective chart review. PARTICIPANTS: We analyzed 30 eyes of 28 patients who previously underwent Boston type 1 keratoprosthesis surgery at our institution between 2004 and 2008. METHODS: Preoperative, intraoperative, and postoperative parameters were collected and analyzed. MAIN OUTCOME MEASURES: Visual acuity and keratoprosthesis stability. RESULTS: Preoperative diagnoses were failed graft (26 eyes, 87{\%}), chemical injury (3 eyes, 10{\%}), and Stevens-Johnson syndrome (1 eye, 3{\%}). Twenty eyes (66{\%}) had preoperative glaucoma. Preoperative best-corrected visual acuity ranged from 20/150 to light perception and was <20/200 in 83{\%} of eyes. At an average follow-up of 19 months (range, 1-48; SD, 13.8; and median, 13), postoperative vision improved to ≥20/200 in 77{\%} of eyes. Among eyes at least 1 year after the operation (16 eyes), vision was ≥20/200 in 75{\%} of eyes and ≥20/40 in 25{\%} of eyes. At an average follow-up of 19 months, retention of the initial keratoprosthesis was 83.3{\%}. CONCLUSIONS: The Boston type 1 keratoprosthesis is a viable option after multiple keratoplasty failures or in conditions with a poor prognosis for primary keratoplasty. Patients with autoimmune disease are at higher risk for complications. The University of California Davis experience seems equivalent to the initial report of the Boston Keratoprosthesis Study Group. With longer follow-up, additional surgical procedures may be required but good anatomic and functional outcomes can be maintained.",
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AB - PURPOSE: To compare the University of California Davis experience using the Boston keratoprosthesis with the Boston Keratoprosthesis Study Group's initial report. DESIGN: Retrospective chart review. PARTICIPANTS: We analyzed 30 eyes of 28 patients who previously underwent Boston type 1 keratoprosthesis surgery at our institution between 2004 and 2008. METHODS: Preoperative, intraoperative, and postoperative parameters were collected and analyzed. MAIN OUTCOME MEASURES: Visual acuity and keratoprosthesis stability. RESULTS: Preoperative diagnoses were failed graft (26 eyes, 87%), chemical injury (3 eyes, 10%), and Stevens-Johnson syndrome (1 eye, 3%). Twenty eyes (66%) had preoperative glaucoma. Preoperative best-corrected visual acuity ranged from 20/150 to light perception and was <20/200 in 83% of eyes. At an average follow-up of 19 months (range, 1-48; SD, 13.8; and median, 13), postoperative vision improved to ≥20/200 in 77% of eyes. Among eyes at least 1 year after the operation (16 eyes), vision was ≥20/200 in 75% of eyes and ≥20/40 in 25% of eyes. At an average follow-up of 19 months, retention of the initial keratoprosthesis was 83.3%. CONCLUSIONS: The Boston type 1 keratoprosthesis is a viable option after multiple keratoplasty failures or in conditions with a poor prognosis for primary keratoplasty. Patients with autoimmune disease are at higher risk for complications. The University of California Davis experience seems equivalent to the initial report of the Boston Keratoprosthesis Study Group. With longer follow-up, additional surgical procedures may be required but good anatomic and functional outcomes can be maintained.

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