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Outcome of the first seventeen Boston Type I keratoprosthesis surgeries in Iraq

Poster Details


First Author: D.Anwar IRAQ

Co Author(s):                     

Abstract Details

Purpose:

Boston type I keratoprothesis (Kpro) is becoming the procedure of choice after multiple failed penetrating keratoplasties (PKP) or for severe neovascularization of the cornea. Here we report the outcome of the first seventeen Boston type I Kpro performed in Iraq.

Setting:

Neega Eye Center

Methods:

Seventeen eyes of sixteen patients underwent Boston type I Kpro with titanium back plate due to previous multiple failed corneal transplants or due to severe neovascularization of the cornea performed by one surgeon (DA).Mean postoperative follow-up was one year. Preoperative best-corrected visual acuity was Light Perception (LP) positive for 5 eyes and hand motion for 8 eyes and finger counting at face for 4 eyes The outcome measures were best-corrected visual acuity, and postoperative complications.

Results:

Postoperative best-corrected visual acuity was 2/200 or better for 9 eyes (Three eyes were 20/60), finger counting at 3-5 meters in 3 eyes, finger counting at face in 3 eyes and no improvement in visual acuity in 2 eyes due to optic atrophy in one eye and deep amblyopia in another eye. All the patients had multiple failed PKPs except for three who had primary Kpro, one of them had multiple failed PKPs in the other eye and two of them had severe vascularized cornea. Six patients had previous Ahmed valve implanted, one had valve implanted after Kpro and the other patient did not have valve implanted. Complications such as melt (3 eyes), retro-prosthetic membrane (3 eyes), and progression of glaucoma (6 eyes) have been reported. Two eyes that developed melt successfully treated by replacing the bandage contact lens. One melt has to be treated by annular patch graft over the melt area. One eye with retro-prosthetic membrane was successfully treated by Nd Yag laser and the other two eyes were not visually significant by the patients to warrant interference. The most common complication is progression of glaucoma. In one eye, implantation of Ahmed valve was needed to control progression. In four eyes the glaucoma progression was control by medications and two eyes developed no light perception from progression of glaucoma, one of the patient lost to follow up to come back with total disc cupping and the other declined to do Ahmed valve. One of the eye (of the two eyes developed no light perception) had LP vision before surgery and after surgery did not improved therefore declined to do valve and went to no light perception. The other eye was of a patient who lost to follow up and his preop vision was hand motion and after Kpro became 20/200. No eyes developed endophthalmitis.

Conclusions:

Boston type I Kpro could be a viable option after multiple failed PKPs or as primary procedure. This is the first 17 Boston Type I Kpro surgeries reported from Iraq

Financial Disclosure:

None

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