No Light Perception Outcomes Following Boston Keratoprosthesis Type 1 Surgery

Muzychuk, Adam; Durr, Georges M.; Shine, Julien J.; Robert, Marie-Claude; Harissi‐Dagher, Mona

doi:10.1016/j.ajo.2017.06.012

Cited by 16 publications

(7 citation statements)

References 47 publications

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“…These included retinal detachment, elevated intraocular pressure, endophthalmitis, and limited vision potential from ocular comorbidities ( 1 ). Aniridia has been found to be a significant risk factor for poor vision outcome (no light perception) in a Canadian study, with most causes from inoperable retinal detachment ( 5 ). Glaucoma is another major cause of vision loss postoperatively, due to difficulty with accurate measurement of intraocular pressure, progressive angle closure, and likely changed biomechanics following Kpro ( 6 ).…”

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confidence: 99%

“…This may be related to aniridia fibrosis syndrome, which involves progressive fibrosis from proximity of intraocular devices to immature vessels in the rudimentary iris ( 7 ). As intraocular lenses can lead to formation of membranes and act as scaffold for RPM, surgeons might consider having a low threshold to explant the intraocular lens and implant an aphakic KPro at the time of surgery ( 5 ). In addition, RPM has been linked to increased risk of retinal detachment ( 8 ).…”

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Commentary: Long-Term Anatomical and Functional Survival of Boston Type 1 Keratoprosthesis in Congenital Aniridia

et al. 2021

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confidence: 99%

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Commentary: Long-Term Anatomical and Functional Survival of Boston Type 1 Keratoprosthesis in Congenital Aniridia

et al. 2021

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“…Com as melhorias no design e nas orientações pós-operatórias, houve uma redução significativa das complicações agudas, como a endoftalmite e a necrose estromal 21,45,53 . Nesse cenário, o prognóstico visual passou a ser limitado por complicações crônicas, como o glaucoma 25,54 . A prevalência de glaucoma é alta, presente entre 36% e 76% dos olhos antes da cirurgia de B-KPro tipo 1, e desenvolvido entre 21% e 75% dos olhos não previamente glaucomatosos 20-23, 55, 56 .…”

Section: Fonte: Cortesia De Massachusetts Eye and Ear Boston Keratoprosthesis 29unclassified

“…O implante do tubo pela pars plana pode diminuir o risco de erosão do tubo, embora a oclusão possa ocorrer em razão de uma vitrectomia incompleta. 25 .…”

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

“…Além disso, a avaliação do nervo óptico e o exame de campo visual podem ser limitados pelo diâmetro da zona óptica da B-KPro tipo 1, assim como pelo possível surgimento da membrana retroprotética, ou pela dificuldade de fixação causada pelo nistagmo 24 . Após o implante da B-KPro tipo 1, o glaucoma também foi reportado como uma das principais causas de perda visual nesse grupo de pacientes 25 .…”

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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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