Transmucosal Boston Type 1 Keratoprosthesis In A Patient With Severe Stevens-Johnson Syndrome
Published 2025 - 43rd Congress of the ESCRS
Reference: PO473 | Type: Free paper | DOI: 10.82333/07y9-hy61
Authors: Erik Mus* 1 , Antonia Maria Luce De Vitto 2 , Antonio Valastro 1 , Simone Febbraro 3 , Francesco Barca 2 , Danilo Iannetta 4 , Luca Ventre 1
1Beauregard Hospital, AUSL Valle d'Aosta,Aosta,Italy, 2Piero Palagi Hospital, AUSL Toscana Centro,Florence,Italy, 3Alma Mater studiorum University of Bologna,Bologna,Italy, 4Sapienza Università di Roma,Rome,Italy
Purpose
To describe the surgical management and postoperative care of a patient with a history of severe Stevens-Johnson Syndrome treated with a transmucosal Boston Type 1 Keratoprosthesis.
Setting
Cornea Service, Barraquer Ophthalmology Center, Barcelona, Spain.
Methods
A 21-year-old female with a history of severe Stevens-Johnson Syndrome secondary to ibuprofen at age 5, resulting in severe ocular sequelae including fornix shortening, symblepharon, limbal insufficiency, conjunctivalization and diffuse corneal opacity. After multiple failed keratoplasties in the right eye (OD) due to recurrent infections, the decision was made to implant a transmucosal Boston Type 1 Keratoprosthesis (B-Kpro). Preoperatively, best-corrected visual acuity (BCVA) was 0.05 in OD and light perception in the left eye (OS).
Results
The surgery was performed in two stages: first, a buccal mucosal graft with temporary tarsorrhaphy, followed by the implantation of the transmucosal Boston Type 1 Keratoprosthesis after two months. Immediate postoperative outcomes showed good progress, but after two weeks, buccal mucosa overgrowth over the keratoprosthesis was observed. This was managed with surgical resection of the excess tissue and the application of 0.1% mitomycin C for one minute. Since then, the patient has remained stable with a BCVA of 0.6 for distance and 0.64 for near vision. Long-term follow-up showed no recurrence of overgrowth or signs of infection.
Conclusions
The transmucosal Boston Type 1 Keratoprosthesis is a viable option for severe corneal pathologies where keratoplasty or limbal transplantation have poor prognosis or have repeatedly failed. The buccal mucosal graft protects the keratoprosthesis from external aggression and, through its vascular supply, helps prevent infections. Mucosal overgrowth affecting the visual axis can be managed by trimming excess tissue and applying 0.1% mitomycin C. This technique is an alternative to osteo-odonto or tibial osteokeratoprosthesis in selected cases. Proper patient selection, surgical expertise and rigorous follow-up are crucial to optimizing outcomes.