Long-term Outcomes of Boston Type I Keratoprosthesis, and Efficacy of Amphotericin B and Povidone-Iodine in Infection Prophylaxis.
Am J Ophthalmol 2021;
232:40-48. [PMID:
34102154 DOI:
10.1016/j.ajo.2021.05.022]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE
To evaluate the long-term outcomes, anatomic retention, and complications of Boston type I keratoprosthesis (KPro).
DESIGN
Retrospective, interventional case series METHODS: A retrospective chart review of implantations performed January 2008-December 2017 was conducted. Risk factors for anatomical retention and functional success were analyzed. The incidences of infections with and without antimicrobial medications were compared.
RESULTS
Twenty-seven eyes of 26 patients were recruited. The most common indication for KPro surgery was failed penetrating keratoplasties (22 eyes, 81.5%). All patients had preoperative best-corrected visual acuity (BCVA) worse than 3/60. Over the mean follow-up of 83.4 ± 28.4 months, 15 eyes (55.6%) demonstrated improved BCVA. The anatomical retention rate was 88.9%, and the functional success rate was 44.4% (retained KPro with BCVA ≥ 3/60). Eyes with ocular surface disease (OSD) had significantly more complications than those without OSD. The most common complications were retroprosthetic membrane formation (15 eyes, 55.6%) and infection (13 eyes, 48.1%). Infectious keratitis was primarily caused by gram-positive bacteria, whereas endophthalmitis was chiefly caused by fungal infection. The infection incidence was significantly lower in eyes using topical 0.1% amphotericin B and 5% povidone iodine (P = .008 and .021, respectively).
CONCLUSIONS
With its good retention rate and visual outcomes, Boston type I KPro could be an alternative treatment for patients with conventional penetrating keratoplasty failure, especially with appropriate patient selection and complication prevention. Standard prophylactic antibiotics with the addition of topical 0.1% amphotericin B and 5% povidone iodine might be optional effective regimens for infection prevention, especially in tropical countries.
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