Boston type 1 keratoprosthesis: The University of California Davis experience

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.