Long-Term Outcomes Of The Boston K-Pro: A 15-Year Follow-Up Study On Bcva, Glaucoma Progression, And Complications

Our project aims to study the evolution of patients who underwent Boston K-Pro surgery over a 15-year period. We examined variables such as the best and final visual acuities, the development of complications such as new or progression of pre-existing glaucoma, need for reintervention, and whether these factors change over time or with reason for the initial operation.

A retrospective chart review was conducted on 157 eyes that underwent Boston K-Pro type 1 surgery, to study progression in multiple outcome areas, such as vision and complications, over a 15-year period.

We analyzed the evolution of these cases across multiple parameters, including visual acuity progression and glaucoma progression, as indicated by changes in the cup-to-disc ratio, visual fields assessed by imaging and examination, and necessary treatments (eye drops, surgeries, or lasers). Postoperative complications were also documented, both specific to the KPro (ex: extrusions, melts, retro-prosthetic membranes) and associated complications (ex: retinal detachments, endophthalmitis, phthisis). Additionally, we reviewed the need for reoperation, including subsequent KPro surgeries, enucleations, or eviscerations.

The study analyzed 156 eyes after Boston KPro implantation over an average of 8.5 years, with a mean patient age of 60.8 years. Aniridia was the most common reason for surgery (25.64%). Visual acuity outcomes were generally poor: 66.66% had a final vision worse than 20/200, consistent across age groups. By 15 years, 80.94% had vision worse than 20/200. The age at surgery did not significantly affect the best or final visual acuity or glaucoma onset. Glaucoma developed in 63.64% of patients without pre-existing disease.

This study highlights that Boston KPro implantation often results in significant complications, particularly in younger patients, though the age at surgery does not appear to impact visual outcomes or glaucoma onset. Most patients experience substantial vision loss over time, regardless of the initial reason for surgery. Glaucoma frequently develops postoperatively, with pre-existing glaucoma patients progressing faster to optic nerve damage than de novo glaucoma. These findings provide insight into when to expect complications, the necessary follow-up, and help set realistic expectations for patients regarding their potential outcomes based on their individual circumstances.