Purpose

To study the long-term visual- and device retention-related outcomes and complications of the Boston Type I Keratoprosthesis (KPro).

Methods

Single-center, retrospective cohort study of all patients undergoing KPro implantation from February 2007 to April 2014 with at least 5 years of follow-up.

Results

68 eyes from 65 patients underwent KPro implantation during the study period. At 5 and 10 years, the probability of maintaining or improving visual acuity (VA) was 75.0% and 66.7%, respectively, and the probability of KPro retention was 89.2% and 89.2%, respectively. Initial device retention rate at 10 years was significantly lower in those with underlying ocular surface disease (46.8% [30.6–63.2] vs 75.8% [61.0–90.7], P = 0.03), while other baseline characteristics showed no significant association. Final VA was more likely to be stable or improved in patients with fewer failed grafts (2 [1–6] vs 3 [1–6], P < 0.01), and a final VA of 20/200 or better was more likely in primary KPro eyes (44.8% [26.7–62.9] vs 19.4% [6.5–32.3], P = 0.03). Combined KPro-vitrectomy eyes were more likely to have stable or improved final VA than non-vitrectomy eyes (88.5% [76.2–100.0] vs 64.1% [49.1–79.1], P = 0.04). All complications had increasing incidence beyond 5 years; in particular, corneal melt, surgical glaucoma interventions, and endophthalmitis tended to have late presentations, with 79.0%, 78.6%, and 88.9% of these complications occurring beyond one year, respectively.

Conclusions

KPro devices show favorable long-term visual and retention outcomes in select patients. Careful long-term, multidisciplinary follow-up is warranted to address potential complications.

中文翻译：

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波士顿I型角膜置换术结局的预测因素：一项长期分析。

目的

研究长期视觉和设备保留相关的结果和波士顿I型角膜假体（KPro）的并发症。

方法

从2007年2月至2014年4月，对所有接受KPro植入的患者进行了单中心，回顾性队列研究，至少随访了5年。

结果

在研究期间，来自65位患者的68只眼睛接受了KPro植入。在5年和10年时，维持或改善视敏度（VA）的概率分别为75.0％和66.7％，KPro保留的概率分别为89.2％和89.2％。患有潜在眼表疾病的患者在10年时的初始器械保留率显着降低（46.8％[30.6-63.2]对75.8％[61.0-90.7]，P  = 0.03），而其他基线特征无显着相关性。移植失败较少的患者的最终VA更可能稳定或改善（2 [1–6] vs 3 [1–6]，P  <0.01），并且最终VA在20/200或更高的可能性更大。 KPro初级眼（44.8％[26.7–62.9] vs 19.4％[6.5–32.3]，P = 0.03）。与非玻璃体切除术相比，KPro玻璃体切除术联合眼睛的最终VA更有可能稳定或改善（88.5％[76.2-100.0]对64.1％[49.1-79.1]，P  = 0.04）。所有并发症的发生率均超过5年。尤其是角膜融化，手术性青光眼干预和眼内炎往往较晚出现，这些并发症的发生率分别为79.0％，78.6％和88.9％超过一年。

结论

KPro设备在选定的患者中显示出良好的长期视觉和保留效果。有必要进行长期的，多学科的随访，以解决潜在的并发症。