Objective To report the retention rate of the Boston Keratoprosthesis Type 1 and to identify risk factors for keratoprosthesis loss. Design Cohort study. Participants 300 eyes of 300 patients who underwent implantation of a Boston Keratoprosthesis Type I device between January 2003 and July 2008 by one of 19 surgeons at 18 medical centers. Methods Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site. Main Outcome Measures Keratoprosthesis retention. Results A total cumulative number of 422 life years of device implantation are included in this analysis. The average duration of follow up was 17.1 ± 14.8 months with a range of one week to over 6.1 years. 93% of the 300 Boston Keratoprosthesis implanted were retained at their last follow up, corresponding to a retention time of 396 patient-years or 1.42 years / keratoprosthesis. The probability of retention after one year and two years was 94% and 89%, respectively. During the study period, 21 (7%) keratoprosthesis implants failed to retain the device; the reasons for keratoprosthesis loss include sterile keratolysis (9), fungal infections (8), dense retroprosthetic membranes (3), and bacterial endophthalmitis (1). Multivariate analysis demonstrated three independent risk factors for keratoprosthesis loss: autoimmune etiology (hazard ratio [HR] = 11.94; 95% confidence interval [CI] 3.31, 43.11), ocular surface exposure requiring a concomitant tarsorrhaphy (HR = 3.43; 95% CI 1.05, 11.22) and number of prior failed penetrating keratoplasties (HR = 1.64; 95% CI 1.18, 2.28). Conclusions The Boston Type 1 Keratoprosthesis appears to be a viable option for eyes that are not candidates for penetrating keratoplasty. Ocular surface disease due to an autoimmune etiology demonstrated the lowest retention rate.

Intracameral cefuroxime and moxifloxacin reduced endophthalmitis rates compared with controls with minimal or no toxicity events at standard doses. Additionally, intracameral antibiotics alone may be as effective as intracameral plus topical antibiotics.

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Vitrectomy for macular detachment due to optic disk pit has good long-term success and results in an improvement in visual acuity. However, adjuvant techniques such as internal limiting membrane peel and temporal endolaser may not improve outcomes, nor does there seem to be a difference between short- and long-acting gases. Patients should be made aware that it can take more than a year and multiple surgeries to achieve foveal reattachment and that increased baseline central retinal thickness is a poor prognostic sign.

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Objective The purpose of this study was to identify possible risk factors for retroprosthetic membrane (RPM) development in a large multicenter cohort of patients receiving a Boston type 1 keratoprosthesis. Design Cohort study. Participants The final analysis included 265 eyes of 265 patients who underwent implantation of a Boston Keratoprosthesis Type I device between January 2003 and July 2008 by one of 19 surgeons at 18 medical centers. Methods Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site. Main Outcome Measures The primary outcome was the presence or absence of a retroprosthetic membrane (RPM) during the follow-up period. Results 265 Boston Type 1 keratoprosthesis surgical procedures (265 patients) from 19 surgeons at 18 surgical centers were included in the analysis. The average age of patients was 63.3±19.1 years, 48.5% of the patients were female, and 52.5% of procedures were performed on the right eye. The mean follow-up time was 17.8±14.9 months. The majority (85.4%; n=222) had undergone an average of 2.2±1.2 (range 1–8) penetrating keratoplasties prior to keratoprosthesis implantation, and 38 eyes (14.6%) received a primary keratoprosthesis. The overall RPM formation rate was 31.7% (n=84). The most significant risk factor for RPM development was infectious keratitis (as a surgical indication for keratoprosthesis surgery itself), resulting in a rate of RPM formation of 70.6%. As an independent risk factor, the hazard ratio (HR) of RPM development in these eyes was 3.20 (95% confidence interval: 1.66, 6.17). Aniridia was also an independent risk factor for RPM development (HR=3.13; 95% confidence interval: 1.10, 8.89). Conclusions RPM formation is a common complication of keratoprosthesis surgery, occurring in approximately one third of cases. Eyes at the highest risk of RPM development are those receiving corneal replacement for infectious keratitis and aniridia.

There was an increased risk for RD in the first 5 months after Nd:YAG, with a return to a baseline plateau thereafter. As such, the rate of retinal tear after Nd:YAG capsulotomy at 5 months was 0.29%, whereas the rate of RD was 0.87%.