Table 1
Patients’ characteristics and procedures performed on patients undergoing Boston Type 1 KPro implantation
| Patient | Indication for KPro, (number of failed grafts)/primary indication | VA preop. | Glaucoma preop. | Lens status | Addit. procedures at time of KPro surgery | VA postop (first year) | VA postop (last visit) | Complication |
|---|---|---|---|---|---|---|---|---|
| PI | Vascularized leucoma after herpetic keratitis | HM | Phakic | ECE | 0,5 | 0,3 | Glaucoma | |
| PII | Failed graft (1)/Vascularized leucoma after herpetic keratitis | LP | Phakic | ECE | 0,6 | 0,4 | Glaucoma | |
| PIII | Failed graft (2)/Corneal leucoma, Axenfeld-Rieger syndrome | CF | Yes | Pseudophakic | AGV | 0,2 | 0,2 | Retroprosthetic membrane, glaucoma, epimacular membrane |
| PIV | Ocular burn | LP | Yes | Phakic | ECE, AGV | LP | LP | Glaucoma, severe MGD |
| PV | Failed graft (3)/Ocular burn | LP | Yes | Aphakic | 0,05 | NLP | End-stage glaucoma, severe MGD, epimacular membrane | |
| PVI | Ocular burn | LP | Yes | Phakic | ECE | NLP | NLP | End-stage glaucoma, severe MGD |
Fig. 1
Representative images of patient's eyes preoperatively and at the last recorded visit; 1a, b. Patient PV.
a. Preoperatively. Failed graft with interrupted sutures. Limbal stem cells deficiency after thermal corneal burn.
b. Postoperatively. Proper BKPro retention. Soft contact lens on ocular surface. Multiple peripheral invasion of blood vessels over the cornea due to limbal stem cell deficiency.
1 c, d. Patient PIII.
c. Preoperatively. Failed graft. Corneal leucoma with calcification and vascularization. Axenfeld-Rieger syndrome.
d. Postoperatively. Proper BKPro retention. No contact lens on ocular surface. Multiple invasion of blood vessels over the cornea exceeding to the device border.
1 e, f. Patient PI.
e. Preoperatively. Post-herpetic keratitis, vascularized leucoma.
f. Postoperatively. Proper BKPro retention. Soft contact lens on ocular surface.
Table 2
Conservative Regimen of Patients After Boston Type 1 keratoprosthesis Implantation recorded at the last visit. (xd. times daily)
| Patient/sex | Antibiotic | Antihypertensive medications | Others |
|---|---|---|---|
| PI/M | 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. | 0.5% timolol 2xd., 0.1% brimonidine 2xd. | lubricant eye drops without preservatives, eyelid hygiene |
| PII/M | 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. | 0.5% timolol 2xd. | |
| PIII/F | 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. | 0.5% timolol 2xd. | |
| PIV/M | 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. | 0.5% timolol 2xd., dorzolamid 2xd., 0.1% brimonidine, 2xd., 0.03% bimatoprost 1xd. | lubricant eye drops, eyelid massage and hygiene, intermittent courses of oral doxycycline |
| PV/M | 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. | 0.5% timolol 2xd., dorzolamid 2xd., 0.1% brimonidine 2xd. | |
| PVI/M | 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. | 0.5% timolol 2xd., 0.1% brimonidine 2xd. |
Table 3
Assessment of the ocular surface status preoperatively (Baseline) and postoperatively at last recorded visit (>10 years)
| Patient | Examination | Schirmer test [mm] | Ocular Staining Score [Oxford grading] | MGD grade |
|---|---|---|---|---|
| PI | Baseline | 14 | 1 | mild |
| >10 years | 10 | moderate | ||
| PII | Baseline | 20 | 0 | mild |
| >10 years | 12 | moderate | ||
| PIII | Baseline | 16 | 1 | moderate |
| >10 years | 15 | moderate | ||
| PIV | Baseline | 8 | 3 | severe |
| >10 years | 4 | severe | ||
| PV | Baseline | 15 | 2 | moderate |
| >10 years | 4 | severe | ||
| PVI | Baseline | 8 | 2 | moderate |
| >10 years | 3 | severe |
Fig. 2
TD OCT representative scans showing complications which occurred in the presented case series.
2 a, b. Patient PII.
a. AS OCT scan 4 weeks postoperatively. Protrusion of the front plate elevated over the ocular surface (arrow). Soft contact lens on the ocular surface. Iris anterior synechiae at 180o with ACA closure (*). ACA open at 0o.
b. HR OCT scan 12 months postoperatively. The protrusion is resolved (arrow). Proper BKPro retention. Soft contact lens on the ocular surface.
c. Patient PIII. AS OCT scan 12 months postoperatively. No contact lens on the ocular surface. Iris atrophy with anterior synechiae (*). Retroprosthetic highly reflective tissue visible behind the optic BKPro part (Retroprosthetic membrane formation) (arrow).
d. Patient PV. AS OCT scan 24 months postoperatively. Anterior iris synechiae with complete ACA closure at 180o (arrow). Soft contact lens on the ocular surface.
e. Patient PIV. AS OCT scan 10 years postoperatively. AGV tube visible at the 180o (*). Note the irregularity of the anterior ocular surface due to severe chemical ocular burn with the pannus formation (arrows). No soft contact lens on the ocular surface.