Boston keratoprosthesis type I in the elderly

Homayounfar, Gelareh; Grassi, Christina M.; Al-Moujahed, Ahmad; Colby, Kathryn; Dohlman, Claes H.; Chodosh, James

doi:10.1136/bjophthalmol-2015-307868

Cited by 13 publications

(8 citation statements)

References 35 publications

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“…20,23,44 Among patients who received a KPro, 1 patient (25%) developed a retrolenticular membrane, which is lower compared with previously reported rates of 33% to 45.5%. 19,25 In our study, an individual who underwent PKP developed a non-expulsive suprachoroidal hemorrhage. While this complication is rare, it has been previously described after corneal transplant with an estimated occurrence of 0.73%.…”

Section: Discussionmentioning

confidence: 85%

“…20,23,44 Among patients who received a KPro, 1 patient (25%) developed a retrolenticular membrane, which is lower compared with previously reported rates of 33% to 45.5%. 19,25…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Despite the increasing aging population, there is limited evidence of the indications and visual outcomes of corneal transplantation in elderly individuals, particularly among those older than 90 years. [15][16][17][18][19][20][21] Parker et al 16 evaluated DMEK surgery in patients older than 90 years with good surgical and visual outcomes. However, to the best of our knowledge, there are no studies evaluating other corneal surgery modalities in this age group.…”

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confidence: 99%

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Considerations for Corneal Surgery With Patients in the 10th Decade of Life

Levine

Naranjo

Martínez

et al. 2021

Cornea

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Purpose:The purpose of this study was to report the indications, ocular and systemic comorbidities, and surgical outcomes of corneal transplantation in patients older than 90 years.Methods:A retrospective review was conducted to identify individuals 90 years and older who underwent corneal transplantation surgery at the Bascom Palmer Eye Institute between January 2013 and October 2020. Outcomes included best-corrected visual acuity and graft survival over time. Paired t tests were used to compare visual acuity preoperatively versus postoperatively. Graft survival was evaluated with Kaplan–Meier curves.Results:Fifty-eight eyes of 52 consecutive individuals were included. The mean age of individuals was 92 ± 2 years; 26.9% were male; and 48.1% self-identified as non-Hispanic White and 38.5% as Hispanic. Postoperative follow-up was 14.7 ± 12.1 months. Of the 58 eyes, 44.8% (26/58) underwent penetrating keratoplasty, 46.6% (27/58) Descemet stripping automated endothelial keratoplasty, and 6.9% (4/58) keratoprosthesis. All surgeries were performed under monitored local anesthesia, without major complications. Surgical indications included pseudophakic bullous keratopathy (36.2%), glaucoma-associated corneal decompensation (27.6%), Fuchs endothelial dystrophy (25.9%), and perforated corneal ulceration (19.0%). The best-corrected visual acuity improved by 0.32 (95% confidence interval 0.14–0.50; P < 0.01) as early as 1 month postoperatively, and vision gains were sustained for at least 12 months. Graft survival probability at 12 months was 88%.Conclusions:Corneal transplantation is a safe and successful procedure in restoring the visual acuity for patients older than 90 years after careful preoperative evaluation. Further research is needed to evaluate the impact of corneal transplantation on quality of life in patients in the 10th decade of life.

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Section: Discussionmentioning

confidence: 85%

“…20,23,44 Among patients who received a KPro, 1 patient (25%) developed a retrolenticular membrane, which is lower compared with previously reported rates of 33% to 45.5%. 19,25…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Considerations for Corneal Surgery With Patients in the 10th Decade of Life

Levine

Naranjo

Martínez

et al. 2021

Cornea

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“…In agreement with short-term studies, better retention rates were observed in non-cicatrizing conditions, ranging from 77% to 97.3%. 19,28,35,38,40,44,50 In contrast, in autoimmuneassociated cicatrizing conditions such as SJS or MMP, retention rates were significantly lower (range 37.5-55%). 42,43 Alexander and colleagues reported that most retention failures in SJS were due to sterile corneal necrosis (78%; 14/18 eyes).…”

Section: Anatomical Retentionmentioning

confidence: 96%

<p>Boston Type 1 Keratoprosthesis: Updated Perspectives</p>

Nonpassopon¹,

Niparugs²,

Cortina³

2020

OPTH

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The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.

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“…Adicionalmente, os pacientes com aniridia eram mais jovens do que os do grupo comparativo. A prevalência de glaucoma aumenta com a idade 80 , embora o efeito da idade no glaucoma relacionado ao B-KPro tipo 1 não tenha sido totalmente investigado 81 .…”

Section: Outras Complicações Após a Cirurgia De B-kpro Tipounclassified

Glaucoma em pacientes com aniridia e ceratoprótese de Boston tipo 1

Silva¹

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Silva RN. Glaucoma in patients with aniridia and Boston type 1 keratoprosthesis [thesis]. São Paulo: "Faculdade de Medicina, Universidade de São Paulo"; 2019. PURPOSE:To compare outcomes related to glaucoma and glaucoma management in eyes with aniridia after Boston Keratoprosthesis (B-KPro) type 1 implantation. METHODS: Eyes with titanium backplate B-KPro type 1 implanted between October 2007 and December 2015 at Massachusetts Eye and Ear, Boston, United States, with more than 2 years of follow-up, were retrospectively studied. Chart data was reviewed for patients with aniridia and patients with other preoperative diagnoses (excluding Stevens-Johnson syndrome, mucous membrane pemphigoid, and congenital ocular disorders with angle distortion). One eye per patient was selected by the longest followup time. The normality of continuous variables was assessed with the Shapiro-Wilk test. T test was used to compare normally distributed continuous variables and Wilcoxon rank-sum test for non-normally distributed variables. The Pearson chi-square test was used to compare categorical variables between groups. RESULTS: The groups aniridia (n = 22) and comparative (n = 61) had similar follow-up time (mean ± standard deviation; 70.7 ± 28.6 months; 63.8 ± 25.5 months, respectively, p = 0.25) and preoperative visual acuity (VA, 1.85 ± 0.35 logMAR; 1.87 ± 0.57 logMAR; p = 0.33). Prior to B-KPro surgery, aniridic eyes showed higher rates of glaucoma diagnosis (76.2%) and glaucoma surgery (57.1%) compared to the second group (51.8%, p = 0.053; 23.2%, p = 0.005, respectively). There was more co-implantation of glaucoma drainage devices concomitantly with B-KPro in aniridia (47.6%) versus comparison eyes (17.9%, p = 0.008). At the final follow-up visit, more eyes with aniridia had glaucoma (90.5%) and at least one glaucoma surgery before, during, or after B-KPro implantation (90.5%), than comparison eyes (64.3%, p = 0.02; 53.6%, p = 0.003). However, both obtained similar rates of cup to disc ratio (CDR) > 0.8 (23.8% vs. 30.4%, p = 0.57) or progression of CDR ≥ 0.2 (42.9% vs. 44.6%, p = 0.89). None of the eyes with prophylactic tube developed glaucoma. The percentages of eyes with at least one serious vision threatening complication were 45.5% in the aniridia group versus 26.2% in the comparative group (p = 0.10). Despite this, the two groups had similar percentages of eyes with VA improvement (72.7%, 72.1%, p = 0.96), and similar postoperative VA at the end of follow-up (1.28 ± 0.79 logMAR, 1.23 ± 0.98 logMAR, p = 0.51). CONCLUSIONS: Despite a high prevalence of glaucoma and other vision threatening complications, B-KPro type 1 surgery can lead to long-term visual rehabilitation in patients with aniridia when a team of trained specialists is available to manage glaucoma and other complications.

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Boston keratoprosthesis type I in the elderly

Abstract: Boston type I keratoprosthesis is an effective modality in corneal blindness in elderly patients. Failure to restore or maintain ambulatory vision was typically due to non-corneal comorbidities, often unrelated to the keratoprosthesis.

Cited by 13 publications

References 35 publications

Considerations for Corneal Surgery With Patients in the 10th Decade of Life

Considerations for Corneal Surgery With Patients in the 10th Decade of Life

<p>Boston Type 1 Keratoprosthesis: Updated Perspectives</p>

Glaucoma em pacientes com aniridia e ceratoprótese de Boston tipo 1

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