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Long-term results of Boston keratoprosthesis surgery in Polish patients

Anna Nowińska
Anna Nowińska
, 
Dariusz Dobrowolski
Dariusz Dobrowolski
, 
Ewa Wróblewska-Czajka
Ewa Wróblewska-Czajka
, 
Ula V Jurkunas
Ula V Jurkunas
 e 
Edward Wylęgała
Edward Wylęgała
   | 14 mar 2022
Postępy Higieny i Medycyny Doświadczalnej's Cover Image
INFORMAZIONI SU QUESTO ARTICOLO
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Article Category: Orginal Study
Pubblicato online: 14 mar 2022
Pagine: 1 - 10
Ricevuto: 23 feb 2021
Accettato: 12 ott 2021
DOI: https://doi.org/10.2478/ahem-2021-0052
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© 2022 Anna Nowińska et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Representative images of patient's eyes preoperatively and at the last recorded visit; 1a, b. Patient PV.a. Preoperatively. Failed graft with interrupted sutures. Limbal stem cells deficiency after thermal corneal burn.b. Postoperatively. Proper BKPro retention. Soft contact lens on ocular surface. Multiple peripheral invasion of blood vessels over the cornea due to limbal stem cell deficiency.1 c, d. Patient PIII.c. Preoperatively. Failed graft. Corneal leucoma with calcification and vascularization. Axenfeld-Rieger syndrome.d. Postoperatively. Proper BKPro retention. No contact lens on ocular surface. Multiple invasion of blood vessels over the cornea exceeding to the device border.1 e, f. Patient PI.e. Preoperatively. Post-herpetic keratitis, vascularized leucoma.f. Postoperatively. Proper BKPro retention. Soft contact lens on ocular surface.
Representative images of patient's eyes preoperatively and at the last recorded visit; 1a, b. Patient PV.a. Preoperatively. Failed graft with interrupted sutures. Limbal stem cells deficiency after thermal corneal burn.b. Postoperatively. Proper BKPro retention. Soft contact lens on ocular surface. Multiple peripheral invasion of blood vessels over the cornea due to limbal stem cell deficiency.1 c, d. Patient PIII.c. Preoperatively. Failed graft. Corneal leucoma with calcification and vascularization. Axenfeld-Rieger syndrome.d. Postoperatively. Proper BKPro retention. No contact lens on ocular surface. Multiple invasion of blood vessels over the cornea exceeding to the device border.1 e, f. Patient PI.e. Preoperatively. Post-herpetic keratitis, vascularized leucoma.f. Postoperatively. Proper BKPro retention. Soft contact lens on ocular surface.

Fig. 2

TD OCT representative scans showing complications which occurred in the presented case series.2 a, b. Patient PII.a. AS OCT scan 4 weeks postoperatively. Protrusion of the front plate elevated over the ocular surface (arrow). Soft contact lens on the ocular surface. Iris anterior synechiae at 180o with ACA closure (*). ACA open at 0o.b. HR OCT scan 12 months postoperatively. The protrusion is resolved (arrow). Proper BKPro retention. Soft contact lens on the ocular surface.c. Patient PIII. AS OCT scan 12 months postoperatively. No contact lens on the ocular surface. Iris atrophy with anterior synechiae (*). Retroprosthetic highly reflective tissue visible behind the optic BKPro part (Retroprosthetic membrane formation) (arrow).d. Patient PV. AS OCT scan 24 months postoperatively. Anterior iris synechiae with complete ACA closure at 180o (arrow). Soft contact lens on the ocular surface.e. Patient PIV. AS OCT scan 10 years postoperatively. AGV tube visible at the 180o (*). Note the irregularity of the anterior ocular surface due to severe chemical ocular burn with the pannus formation (arrows). No soft contact lens on the ocular surface.
TD OCT representative scans showing complications which occurred in the presented case series.2 a, b. Patient PII.a. AS OCT scan 4 weeks postoperatively. Protrusion of the front plate elevated over the ocular surface (arrow). Soft contact lens on the ocular surface. Iris anterior synechiae at 180o with ACA closure (*). ACA open at 0o.b. HR OCT scan 12 months postoperatively. The protrusion is resolved (arrow). Proper BKPro retention. Soft contact lens on the ocular surface.c. Patient PIII. AS OCT scan 12 months postoperatively. No contact lens on the ocular surface. Iris atrophy with anterior synechiae (*). Retroprosthetic highly reflective tissue visible behind the optic BKPro part (Retroprosthetic membrane formation) (arrow).d. Patient PV. AS OCT scan 24 months postoperatively. Anterior iris synechiae with complete ACA closure at 180o (arrow). Soft contact lens on the ocular surface.e. Patient PIV. AS OCT scan 10 years postoperatively. AGV tube visible at the 180o (*). Note the irregularity of the anterior ocular surface due to severe chemical ocular burn with the pannus formation (arrows). No soft contact lens on the ocular surface.

Patients’ characteristics and procedures performed on patients undergoing Boston Type 1 KPro implantation

Patient Indication for KPro, (number of failed grafts)/primary indication VA preop. Glaucoma preop. Lens status Addit. procedures at time of KPro surgery VA postop (first year) VA postop (last visit) Complication
PI Vascularized leucoma after herpetic keratitis HM Phakic ECE 0,5 0,3 Glaucoma
PII Failed graft (1)/Vascularized leucoma after herpetic keratitis LP Phakic ECE 0,6 0,4 Glaucoma
PIII Failed graft (2)/Corneal leucoma, Axenfeld-Rieger syndrome CF Yes Pseudophakic AGV 0,2 0,2 Retroprosthetic membrane, glaucoma, epimacular membrane
PIV Ocular burn LP Yes Phakic ECE, AGV LP LP Glaucoma, severe MGD
PV Failed graft (3)/Ocular burn LP Yes Aphakic 0,05 NLP End-stage glaucoma, severe MGD, epimacular membrane
PVI Ocular burn LP Yes Phakic ECE NLP NLP End-stage glaucoma, severe MGD

Conservative Regimen of Patients After Boston Type 1 keratoprosthesis Implantation recorded at the last visit. (xd. times daily)

Patient/sex Antibiotic Antihypertensive medications Others
PI/M 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. 0.5% timolol 2xd., 0.1% brimonidine 2xd. lubricant eye drops without preservatives, eyelid hygiene
PII/M 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. 0.5% timolol 2xd.
PIII/F 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. 0.5% timolol 2xd.
PIV/M 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. 0.5% timolol 2xd., dorzolamid 2xd., 0.1% brimonidine, 2xd., 0.03% bimatoprost 1xd. lubricant eye drops, eyelid massage and hygiene, intermittent courses of oral doxycycline
PV/M 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. 0.5% timolol 2xd., dorzolamid 2xd., 0.1% brimonidine 2xd.
PVI/M 0.5% vancomycin 1xd. 0.5% moxifloxacin 1xd. 0.5% timolol 2xd., 0.1% brimonidine 2xd.

Assessment of the ocular surface status preoperatively (Baseline) and postoperatively at last recorded visit (>10 years)

Patient Examination Schirmer test [mm] Ocular Staining Score [Oxford grading] MGD grade
PI Baseline 14 1 mild
>10 years 10 moderate
PII Baseline 20 0 mild
>10 years 12 moderate
PIII Baseline 16 1 moderate
>10 years 15 moderate
PIV Baseline 8 3 severe
>10 years 4 severe
PV Baseline 15 2 moderate
>10 years 4 severe
PVI Baseline 8 2 moderate
>10 years 3 severe
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