Table 2.
Results of Boston Keratoprosthesis Case Series for Specific Indications
| Author /Year /Country |
Cohort | N=Eyes | Mean Follow-Up Time [Range] (Months) | Primary BKPro | Indication | Preoperative BCVA ≥20/200 | Postoperative BCVA ≥ 20/200 | Anatomical Retention Rate at Last Follow-Up | Complications |
|---|---|---|---|---|---|---|---|---|---|
| Homayounfar38 2017, USA |
Age ≥ 75 years | 44 | 27.12 [0.8–72] | 47.7% | Graft failure 52.3%, Corneal scar 18.2%, LSCD 18.2% |
0% | 45.45% at last follow-up | 89% | RPM 45.5%, CME 13.6%, Elevated IOP 9.1%, Kpro-replacement 11.4%, Microbial keratitis 9.1%, Endophthalmitis 6.8%, Sterile vitritis 6.8% |
| Fung27 2018 Canada |
Children ≥16 years | 11 | 26.7 [6.5–85] | 55% | Aniridia 45%, Peters type II 45% |
0% | N/A (worse 55%, same 27%) | 36% | RPM 82%, Corneal melt 45%, RD 45%, Infectious keratitis with endophthalmitis 27% |
| Aravena39 2016 USA |
LSCD vs non-LSCD | 54 vs 95 | 37.1±26.4 vs 38.2± 28.9 | 40.7% vs 2.1% | Graft failure 25.9%, Chemical injury 20.4%, SJS 18.5% |
7% vs 9% | 76% vs 51% at 2 yrsǂ, 85% vs 46% at 5 yrsǂ | 94.4% vs 86.3% | RPM 37% vs 54%ǂ, PED 50% vs 28%ǂ, Sterile stromal necrosis 22% vs 10%, Corneal infiltrate 20% vs 9%, Endophthalmitis 0% vs 2.1%, BKPro removed 22.2% vs 20% |
| Goins40 2016 USA |
OSD (no vs mild to moderate vs severe) | 75 | 41.4 [0.8–82.8] | 20% | No OSD 49.3%, Mild to moderate OSD 20%, Severe OSD 30.6% |
26.7% | N/A (probability of improve vision at 5 yrs 53%) | 85.3% | RPM 29.7% vs 40% vs 34.8%, Endophthalmitis 5.4% vs 0% vs 21.7% ǂ, Ulcerative keratitis 5.4% vs 6.7% vs 39.1%ǂ |
| Sayegh41 2008 USA |
SJS (BKPro I, II) |
TBKpro I 6 | 43.2±18 [10.2–67.2] | 44% | SJS 94%, TEN 6% |
0% | 50% at last follow-up, (BCVA>20/40 31.25%) | N/A | RPM 56%, Tissue melt and leak 25%, New glaucoma 19%, Endophthalmitis 0%, |
| Palioura42 2013 USA |
MMP (BKPro I, II) | TBKpro I 8 | 38.4±25.2 | 50% | MMP 100% | 0% | 12.5% at last follow-up | 37.5% | RPM 62.5%, Extrusion 62.5%, RD 37.5%, Endophthalmitis 0% |
| Alexander43 2015 Multicentre |
Non-SJS vs SJS | 182 vs 27 | 29.3 vs 17.6ǂ | 23.1% vs 66.7%ǂ | Graft failure 56.2%, LSCD 12.4% |
5% vs 0% | 63% vs 96% at last follow-upǂ | 84% vs 55%ǂ | RPM 49% vs 37%, Corneal necrosis 8.3% vs 59.3%ǂ, PED 24.3 vs 59.3%ǂ, Endophthalmitis 2.2% vs 0% |
| Shah44 2018 USA |
Aniridia | 46 | 54±19.2 [24–88.8] | 26% | Aniridia 100% | 7% | N/A (43.5% BCVA improve ≥ 2 lines at last follow-up) | 87% | RPM 61%, New onset or progression of glaucoma 26% |
| Salvador-Culla 45 2016 Dominican- Republic |
Severe ocular burn | 42 | 40.2±24.4 [6–98] | N/A | Severe ocular burn | 0% | 58% at 3yrs, 77% at 5 yrs | 91.4% at 2 yrs | PCO 52.4%, Glaucoma 33.3%, RPM 11.9%, Corneal melting 31%, RD 4.8%, Vitritis 4.8%, Endophthalmitis 2.4% |
| Shanbhag46 2018 USA |
Chemical injury (systemic review) |
106 | 24.99±14 | N/A | Alkali and acid burn | N/A | 64.15% at last follow-up | 88.8% at 2 yrs | Valve implantation 10.8%, CPC 4.9%, Removal of KPro 11.76%, Glue application 4.9%, Surgeries for RD 3.9% |
| Brown47 2014 USA |
HSV vs HZV | 5 vs 4 | 48.4 vs 50.5 | 0% vs 25% | - | 20% vs 25% | 100% vs 25% at last follow-upǂ | 100% vs 25%ǂ | Wound dehiscence 0% vs 75%ǂ, Microbial keratitis 0% vs 75%ǂ, Glaucoma escalation 40% vs 0%, Endophthalmitis 0% vs 50%, CME 0% vs 25% |
| Fry48 2018 USA |
HSV vs controlled | 11 vs 138 | 43.6±24.2 vs 41.2±30.0 | 9% vs 32% | Control group; Graft failure 68.8% | 9% vs 8% | 60% vs 62% at 3 yrs | 64% vs 91%ǂ | RPM 45.5% vs 48.8%, PED 63.6% vs 34.1%, CME 45.5% vs 12.3%ǂ, Corneal infiltrate 27.3% vs 12.3%, Elevated IOP 27.3% vs 15.2%, Sterile vitritis 18.2% vs 9.4% |
Notes: ǂStatistically significant difference. N/A: Not available-either the respective values were not reported or reported in other formats.
Abbreviations: BCVA, best-corrected distance visual acuity; BKpro, Boston keratoprosthesis; SJS, Steven’s Johnson syndrome; TEN, toxic epidermal necrolysis; LSCD, limbal stem cell deficiency; OSD, ocular surface diseases; MMP, mucous membrane pemphigoid; HSV, herpes simplex viral infection; HZV, herpes zoster viral infection; RPM, retroprosthetic membrane; PCO, posterior capsular opacification; PED, persistent epithelial defect; IOP, intraocular pressure; CME, chronic macular edema; RD, retinal detachment.