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Long-term results of Boston keratoprosthesis surgery in Polish patients Cover

Long-term results of Boston keratoprosthesis surgery in Polish patients

Postępy Higieny i Medycyny Doświadczalnej
Volume 76 (2022): Issue 1 (January 2022)
By: Anna Nowińska,  Dariusz Dobrowolski,  Ewa Wróblewska-Czajka,  Ula V Jurkunas and  Edward Wylęgała  
Open Access
|Mar 2022

Figures & Tables

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.
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.

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.
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.

Patients’ characteristics and procedures performed on patients undergoing Boston Type 1 KPro implantation

PatientIndication for KPro, (number of failed grafts)/primary indicationVA preop.Glaucoma preop.Lens statusAddit. procedures at time of KPro surgeryVA postop (first year)VA postop (last visit)Complication
PIVascularized leucoma after herpetic keratitisHM PhakicECE0,50,3Glaucoma
PIIFailed graft (1)/Vascularized leucoma after herpetic keratitisLP PhakicECE0,60,4Glaucoma
PIIIFailed graft (2)/Corneal leucoma, Axenfeld-Rieger syndromeCFYesPseudophakicAGV0,20,2Retroprosthetic membrane, glaucoma, epimacular membrane
PIVOcular burnLPYesPhakicECE, AGVLPLPGlaucoma, severe MGD
PVFailed graft (3)/Ocular burnLPYesAphakic 0,05NLPEnd-stage glaucoma, severe MGD, epimacular membrane
PVIOcular burnLPYesPhakicECENLPNLPEnd-stage glaucoma, severe MGD

Conservative Regimen of Patients After Boston Type 1 keratoprosthesis Implantation recorded at the last visit_ (xd_ times daily)

Patient/sexAntibioticAntihypertensive medicationsOthers
PI/M0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd.0.5% timolol 2xd., 0.1% brimonidine 2xd.lubricant eye drops without preservatives, eyelid hygiene
PII/M0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd.0.5% timolol 2xd.
PIII/F0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd.0.5% timolol 2xd.
PIV/M0.5% 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/M0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd.0.5% timolol 2xd., dorzolamid 2xd., 0.1% brimonidine 2xd.
PVI/M0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd.0.5% timolol 2xd., 0.1% brimonidine 2xd.

Assessment of the ocular surface status preoperatively (Baseline) and postoperatively at last recorded visit (>10 years)

PatientExaminationSchirmer test [mm]Ocular Staining Score [Oxford grading]MGD grade
PIBaseline141mild
>10 years10moderate
PIIBaseline200mild
>10 years12moderate
PIIIBaseline161moderate
>10 years15moderate
PIVBaseline83severe
>10 years4severe
PVBaseline152moderate
>10 years4severe
PVIBaseline82moderate
>10 years3severe
DOI: https://doi.org/10.2478/ahem-2021-0052 | Journal eISSN: 1732-2693
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Language: English
Page range: 1 - 10
Submitted on: Feb 23, 2021
Accepted on: Oct 12, 2021
Published on: Mar 14, 2022
Published by: Hirszfeld Institute of Immunology and Experimental Therapy
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
cornea,
keratoprosthesis,
optical coherence tomography,
dry eye disease
Related subjects:
Life sciences,
Molecular biology,
Microbiology and virology,
Medicine,
Basic medical science,
Immunology

© 2022 Anna Nowińska, Dariusz Dobrowolski, Ewa Wróblewska-Czajka, Ula V Jurkunas, Edward Wylęgała, published by Hirszfeld Institute of Immunology and Experimental Therapy
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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