This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 . Study registered on ClinicalTrial.gov number: NCT01999790.
PurposeTo report the outcomes of implantation of the Boston Type I keratoprosthesis in three patients with Acanthamoeba keratitis (AK), a severe infection that can lead to significant visual loss.ObservationsCase series reporting three patients with difficult cases of AK that needed multiple corneal transplantations and glaucoma surgeries. All patients were implanted with the Boston Type I keratoprosthesis device. The main outcomes measure were the visual function and anatomical retention after implantation of the Boston Type I keratoprosthesis. All patients retained the device over the long-term and had good visual function. In one patient a retroprosthetic membrane developed and in another patient an epithelial lip developed over the anterior surface of the keratoprosthesis. The visual acuities range from 20/25 to 20/80 in the implanted eyes.Conclusions and importanceThe Boston Type I keratoprosthesis resulted in good anatomic and functional results after multiple graft failures after AK.
Purpose: To determine visual field findings in Boston type 1-KPro (BI-KPro) patients without glaucoma. Characterize normal threshold values and global indices using standard automated perimetry and characterize visual field amplitude using Goldmann's manual perimetry.Methods: This cross-sectional prospective noninterventional study included patients (n = 6 patients, 6 eyes) with BI-KPro who had normal optical coherence tomography and fundoscopic evaluation of the optic disc and retina. None had a previous history of glaucoma. Visual acuity, reliable and reproducible standard automated perimetry (24-2 and 30-2), and manual perimetry examinations were obtained from all patients. Each patient answered the National Eye Institute Visual Function Questionnaire, and the results were correlated with visual field indices.Results: The mean visual acuity was 0.35 ± 0.31 logMAR (0.84 to 0.10). All visual fields had good reliability indices. The standard automated perimetry mean deviation values were −7.25 ± 3.63 decibels (dB) and −7.75 ± 3.23 (24-2 and 30-2 values, respectively), whereas pattern SD values were 2.72 ± 0.82 and 3.30 ± 1.13 (24-2 and 30-2, respectively). The manual visual field mean values of the 4 quadrants (superior, temporal, inferior, and nasal), were 39.7 ± 4.5, 61.8 ± 6.2, 54.0 ± 4.3, and 48.2 ± 7.6 degrees, respectively. The authors found a significant correlation between the VFQ-25 indexes of general sight and close-range activities with the values of total deviation at 10 degrees. VFQ-25 peripheral vision indexes also correlated significantly with values of total deviation at 30 degrees (outermost locations in the 30-degree area).Conclusions: Patients with BI-KPro presented reliable and reproductive visual field measurements. The authors found a consistent reduction in visual field extension and a global sensitivity reduction in these patients. Despite visual field changes, our patients had a good quality of life scores. Overall, these results could be useful to improve early glaucoma diagnosis and to follow-up BI-KPro patients.
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