Purpose Blindness due to corneal disease accounts for approximately 8 million of the 37 million blind in the world. A 2007 study confirmed the global cost‐effectiveness (CE) of cataract surgery and penetrating keratoplasty (PK). We sought to determine the CE of the Boston Keratoprosthesis. Methods In a retrospective chart review, patients who underwent KPro type I surgery in the United States over the last 5 years were identified. Patients had to have a minimum of 2 years of visual acuity follow‐up data. Patients with autoimmune diseases and chemical burns were excluded. Eighty‐three patients were included. CE was determined by cost‐utility analysis (CUA). Complications and additional procedures were incorporated into a weighted cost decision tree. A conservative retention estimate of 85% was assumed at 5 years. Visual acuity values were converted to utilities and determined to be normally distributed per Shapiro‐Wilk testing. Results The mean preoperative utility value was 0.449 increasing to 0.630 postoperatively. The mean incremental utility was 0.182. Amongst our cohort, 65 patients experienced improvement in their BSCVA at 2 years, 13 experienced no improvement, and 5 deteriorated. A total discounted incremental QALY gain of 0.763 was obtained. The total discounted cost associated with this utility equaled $11250 (USD). The cost‐utility of the KPro was $13106 per QALY. The model was assessed using both univariate and multivariate sensitivity analyses. Conclusion The KPro is becoming an established procedure in the US for complex ophthalmic patients, often with numerous comorbidities. The cost effectiveness of KPro was determined in this study to be $13106 USD per QALY. This is comparable to PK, which has been reported in the range of $12000‐16000 USD per QALY.
Purpose To assess the sustainability of the Type I Boston Keratoprosthesis in the developing world and report 18‐month follow‐up data on the International Boston Keratoprosthesis Study Group pilot project in Ethiopian. Methods Through an international collaboration between the Massachusetts Eye and Ear Infirmary, USA and the Menelick II Hospital, Ethiopia, six pre‐selected patients underwent surgery with th Type I Boston Keratoprosthesis (KPro). Patient inclusion criteria included hospital access, multiple graft failure, or binocular blindness. An International Protocol was developed to standardize evaluation and follow‐up. To reduce costs, the patient’s own cornea was used as a carrier for the KPro when possible instead of a donor cornea. Follow‐up reports were transmitted electronically to all physicians involved. Results Six Ethiopian patients received a Boston KPro under local anesthesia without complications. In two patients, their own cornea was used as a carrier for the KPro. All patients had improved visual acuity from a baseline vision of hand motions. Postoperative vision ranged from CF at 5m to 20/40. All patients were able to self‐administer their ophthalmic medications and five of six patients reported greater independence in ADLs. There were no infections, or compliance issues. Conclusion Early results indicate that the Boston KPro may be an option in the developing world. KPro complication rates were no different from developed countries. The use of the patient’s own cornea was not associated with a poor outcome. It remains unclear as to whether KPro may be superior to PK in this setting. Careful patient selection, standardized protocol implementation, and meticulous post‐operative follow‐up are necessary for long‐term sustainability.
Purpose Following implantation of a Boston Keratoprosthesis (BKPro), formation of a retroprosthetic membrane (RPM) is an indication of postoperative intraocular inflammation. The purpose of this retroactive study has been to compare BKPro back plates made of titanium with the standard PMMA back plates. Any difference in RPM formation would guide our future choice of material for the device. Methods The design was a retroactive analysis looking at the surgical outcomes after 6 months in patients who had BKPro implants. Pediatric cases were excluded. The indications for having a KPro implant were broadly divided into three categories: autoimmune (n=12), chemical burns (n=11), and others (non‐autoimmune) (n=55). Three types of back plates were studied: 1) threaded (screw‐on) PMMA (n=39), 2) non‐threaded (snap‐on) PMMA (n=16) and 3) non‐threaded titanium back plates (n=23). Main outcome measured was incidence of RPM formation at 6 months after surgery that warranted removal by either YAG laser membranotomy or surgery. Results The percentage of patients who developed RPM was greatest in the threaded PMMA group (46%), followed by the non‐threaded PMMA (31%), although this difference did not achieve statistical significance (p=0.5). The non‐threaded titanium group showed the least RPM formation (13%), which was significantly less than both the threaded PMMA (p=0.002) and the threadless PMMA (p=0.043) groups. Conclusion Titanium KPro back plates induce less RPM than PMMA back plates, threaded or non‐threaded. It seems that the titanium plates in this setting are more tissue friendly and cause less inflammation than PMMA.
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