Prospective evaluation of the Boston keratoprosthesis

Abstract

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.

Boston type 1 keratoprosthesis from patient selection through postoperative management: a review for the keratoprosthetic surgeon

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“…Typically, contact lenses are exchanged every 3–4 months, but may be discarded at different intervals depending on individual patient characteristics. 28 …”