Boston Keratoprosthesis Type 1 In A Patient With Bilateral Alkali Burn

To report a case of a Boston keratoprosthesis type 1 in a patient with bilateral alkali burn. 

Oftalmosalud, Lima, Peru 

A 21 year-old, previously healthy, male presented to the ophthalmology clinic with blurred vision due to bilateral eye caustic burn with a tank of sodium hydroxide (NaOH) one month and a half ago, who has been hospitalized twice for one month and 2 weeks, respectively, due to skin burns and sistemic complications since the event. He has been treated with moxifloxacin every 4 hours for 5 weeks, Prednisolone 1% every 6 hours, Lubricating tear drops every 6 hours and tetracycline in unguent every 6 hours. 

On examination, conjunctival hyperemia, corneal neovascularization 360º, stem cell insufficiency and corneal edema with a central ulcer of 8.9 x 4.6 mm in his right eye and 7.6 x 4.6 mm on his left eye. Additionally, anterior chamber was formed, apparent cataract, discoric pupil, no signs of infection and, intraocular pressure was normal.

Initially, he was performed an amniotic membrane graft with tyssel on both eyes and used corticoesteroids during 3 weeks, cyclosporine, Loteprednol, moxifloxacin and dorzolamide+ timolol + Brimonidine twice a day for several months, later on a simple limbal epithelial transplantation (SLET) was made, and, ultimately on September 2023, a Boston type 1 Keratoprosthesis was performed without complications. 

Boston Keratoprosthesis type 1 is a great alternative for severe corneal diseases due to limbal stem cell deficiency, corneal neovascularization or corneal edema with a poor prognosis, which can provide a better visual acuity and anatomical retention to the patient.