Long-Term Outcomes Of Boston Type 1 Keratoprosthesis
Published 2026 - 44th Congress of the ESCRS
Reference: FP22.15 | Type: Free paper | DOI: 10.82333/arma-vg38
Authors: Dr Raul E. Ruiz-Lozano 1 , Dr Robert Schwartz 1 , Dr Raiza A. Perez-Lucena 1 , Dr Arturo Balaguer 1 , Dr Zarife Jale Yucel 1 , Dr Ali Khodor 2 , Dr Nicholas W. Setter* 1 , Dr Jose de la Cruz 1 , Dr Maria S. Cortina 1
1Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary,University of Illinois Chicago,Chicago,United States, 2Bascom Palmer Eye Institute,University of Miami,Miami,United States
Purpose
Analyze the influence of risk factors at presentation in the long-term outcomes of Boston keratoprosthesis (KPro) type 1
Setting
Retrospective single-center study including 206 eyes (192 patients) who underwent KPro surgery at the Illinois Eye & Ear Infirmary between June 2006 and December 2025.
Methods
Data at presentation on demographics, ocular history, and KPro surgery were analyzed with multivariable analysis using the Cox proportional hazard model (adjusted hazard ratio [aHR] and 95% confidence intervals [CIs]) to identify factors associated with (1) KPro retention failure, defined as device replacement with a standard keratoplasty or enucleation; (2) vision loss, defined as loss of >3 Snellen lines from the best-ever acuity achieved after surgery; and (3) postoperative complications. A sub-analysis of 127 eyes in whom KPro was implanted >10 years ago (between June 2006 and November 2015) was also performed.
Results
165/206 eyes (80%) retained their KPro (6.28 years/Kpro) and 41/206 (20%) did not. Age <16 years (aHR 3.7; 95% CI: 1.5–9.4) and autoimmune disease (aHR 2.6; 95% CI: 1.2–5.6) were associated with KPro failure. Vision improved in 175/202 (87%) eyes. Of those, 97 (55%) maintained visual improvement. Autoimmune disease (aHR 1.9; 95% CI: 1.0–3.4) and concomitant tarsorrhaphy (aHR 2.6; 95% CI: 1.0–6.5) were associated with vision loss. Major complications included RPM (50%), glaucoma progression (30%), and corneal melt (19%). Of 127 eyes with a KPro implanted >10 years ago, 80% and 51% retained their KPro and vision, respectively. White Hispanics and tarsorrhaphy were associated with KPro failure (both p<.05), and no variables with vision loss.
Conclusions
The Boston type 1 KPro remains a viable alternative for eyes in which conventional keratoplasty does not offer a reasonable expectation of success. Eyes with an ocular surface disease secondary to an autoimmune cause that underwent KPro surgery are at an increased risk of retention failure and vision loss. Pediatric KPro was associated with an increased risk of device failure. Interestingly, there appears to be racial differences in White Hispanics who had worse retention outcomes. Studies are necessary to understand better and address these disparities.