Anatomical Results And Complications Of Type I Boston Keratoprosthesis With Oral Mucosa Overlay

To describe the anatomical success and complications in Type 1 Boston keratoprosthesis with oral mucosa overlay.

Oftalvist Barcelona. The study was carried out according to the principles of the Declaration of Helsinki. Given its retrospective nature, all participants had previously provided informed consent for the use of their data in research.

Oral mucosa can be used as an adjunct to the Type I Boston KPro in challenging cases, such as repeated prosthesis extrusion or cases of high risk of stromal melts. A total of 29 eyes which underwent surgery by a single surgeon (MDP) were reviewed. The most common indication auto-immune corneal opacity such as Stevens-Johnson syndrome or ocular cicatricial pemphigoid followed by severe chemical burns, and others like congenital aniridia, severe neurotrophic keratopathy, etc.

Anatomical success was defined as prosthesis retention at last follow up. Mean follow up time was 34 months. Among 29 eyes, overall anatomic success was 90% (26/29) and failure 10% (3/29). Anatomic failure was exclusively associated with infection, and in patients with autoimmune disease and immune suppression. Oral mucosa complications were central necrosis (7) and mucosal overgrowth (3), but all maintained anatomic survival. Severe chemical burns showed 100% anatomical success at last follow up. Tthe most common factor encountered in cases of mucosal complications was smoking: 66% of smokers (4/6) versus 8% of non-smokers (2/23). Although not statistically significant, there there seems to be a trend for stromal complications in smokers.

Oral mucosa overaly may be  an adjunct in challenging cases of  Type I Boston KPro surgery. Anatomical failure or loss of prosthesis was exclusively related to infectious complications occurring in patients with auto immune diseases, suggesting systemic immune dysregulation may increase susceptibility to infection. Smoking was strongly associated with mucosal complications but did not correlate with infection or device loss.