Official ESCRS | European Society of Cataract & Refractive Surgeons

Long-term results of Boston keratoposthesis for unilateral corneal disease.

Session Details

Session Title: Cornea
Session Date/Time: Sunday 22/02/2015 | 08:30-11:00
Paper Time: 09:57
Venue: Hall 2
First Author: : M.Kosker TURKEY
Co Author(s): :    K. Suri   C. J. Rapuano   B. D. Ayres   P. K. Nagra   I. M. Raber   K. M. Hammersmith

Abstract Details


Patients with good vision in one eye were not traditionally considered good candidates for keratoprosthesis implantation because of guarded visual prognosis, considerable long-term risk and various postoperative complications associated with BKPro surgeries, and consequently, keratoprostheses were considered only for patients with bilateral severe visual impairment. Improved vision-related quality of life and patient safety resulting from better visual acuity in the affected eye may be important indications for Boston keratoprosthesis (BKPro) implantation in patients with unilateral visual impairment. Aim of our study was to report the results of unilateral implantation of BKPro in patients with good visual acuity in fellow eye.


Cornea Service of the Wills Eye Hospital


A retrospective analysis of patients that underwent an optical BKPro implantation was performed. All cases that underwent an optical BKPro, and had a preoperative best-corrected visual acuity 20/40 or better in the fellow eye were included. We set criteria for eligibility of patients for keratoprosthesis implantation as such: 1) visually significant corneal opacification (best corrected visual acuity<20/200); 2) eyes without good potential for repeat corneal transplantation due to a history of failed transplantations, extensive corneal limbal stem cell failure with or without corneal vascularization or scarring. Patients were excluded if they had less than 1 year of postoperative follow-up.


The mean follow-up after BKPro implantation was 31.7 months (range, 12–78 months; SD, 21). Twenty-eight patients had BKPro for failed penetrating keratoplasty and 9 patients had a primary BKPro. The most common complications were elevated intraocular pressure and retroprosthetic membrane formation in 16 eyes (43%) each. Mean final BCVA (1.03±0.75 logMAR) was statistically better than mean preoperative BCVA (1.81±0.16 logMAR) (p<0.001). The probability of postoperative BCVA better than 20/200 was 54.1% at an average 45.1±4.7 months follow-up. The probability of postoperative BCVA of 20/40 or better was 37.8% at average 51.8±4.9 months follow-up.


The most common indication for BKPro transplant was failed penetrating keratoplasty performed for PBK in 43% patients followed by keratoconus and chemical injury. Nine eyes had primary BKPro procedure due to high risk of graft failure because of limbal stem cell deficiency and corneal vascularization. Half of the patients in our study achieved minimum visual acuity required for binocular functioning while one third achieved BCVA somewhat similar to the contralateral eye. The complications were similar to those reported previously with good retention of the device. BKPro implantation is a reasonable option for patients with good vision in the fellow eye.

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