Boston Type 1 Keratoprosthesis Vs. Repeat Penetrating Keratoplasty For Single Corneal Graft Failure: Real-World Experience From A Tertiary Care Center

To compare the outcomes of Boston type 1 keratoprosthesis (KPro) vs. repeat penetrating keratoplasty in patients with a single corneal graft failure.

Single-center, retrospective, cohort study of eyes with a history of one failed PKP.

Post-PKP eyes were divided into two groups; those who underwent repeat PKP and those who underwent KPro surgery at the Illinois Eye & Ear Infirmary. Outcomes included visual acuity improvement and graft failure or KPro retention failure, defined as device replacement with standard PKP or enucleation. Groups comparisons were made with the Fisher exact test or Mann-Whitney U test, as appropriate. A P-value of <0.05 was deemed statistically significant.

A total of 101 eyes were included for analysis; 47 (47%) eyes underwent repeat PKP and 54 (53%) KPro surgery. The median follow-up time was significantly in the KPro surgery group (67 months, range: 26–121 months) compared with the repeat PKP group (20 months, range: 6–38 months) (P < 0.001). Graft failure (n = 21/47, 45%) was significantly more frequent than KPro retention failure (n = 10/54, 19%) (P = 0.005). Compared with baseline, the proportion of eyes experiencing visual improvement was non-significantly higher in the KPro surgery (n = 28/54, 52%) compared with the repeat PKP group (n = 30/74, 41%) (P = 0.235).

Despite longer follow-up, the KPro group showed increased survival compared to repeat PKP in eyes with single corneal graft failure. Both interventions showed similar visual outcomes. Larger studies with extended follow-up are required to validate these conclusions.

*Note: Due to time issues, this is only a preliminary analysis. A thorough study including a larger sample and analyzing for risk factors associated with graft failure will be analyzed with multivariable analyses and Kaplan-Meier plots for final presentation.