Boston Type 1 Keratoprosthesis for Chemical and Thermal Injury

作者：Phillips David L; Hager Jonathan L; Goins Kenneth M; Kitzmann Anna S; Greiner Mark A; Cohen Alex W; Welder Jeffrey D; Wagoner Michael D^*

来源：Cornea, 2014, 33(9): 905-909.

DOI：10.1097/ico.0000000000000204

• chemical injury
• thermal injury
• Boston type 1 keratoprosthesis
• penetrating keratoplasty
• limbal stem cell transplant
• graft failure
• sterile corneal ulceration
• microbial keratitis
• endophthalmitis

Purpose: To evaluate the outcome of the Boston type 1 keratoprosthesis (Kpro-1) in eyes with failed interventions for chemical and thermal injury.
Methods: A retrospective review was performed of every eye with chemical or thermal injury that was treated with a Kpro-1 at a tertiary eye care center between January 1, 2008 and July 1, 2013. The main outcome measures were visual outcome, prosthesis retention, and postoperative complications.
Results: Nine eyes met the inclusion criteria, including 7 eyes with alkali burns, 1 eye with an acid burn, and 1 eye with a thermal burn. After a mean follow-up of 40.7 months (range, 29-60 months), the median best-corrected visual acuity was 20/60 (range, 20/15 to no light perception). One eye was >= 20/20, 3 eyes were >= 20/40, and 6 eyes were >= 20/70. The initial Kpro-1 prosthesis was retained in 7 (77.7%) eyes and successfully replaced in the other 2 eyes. One or more serious complications occurred in 6 (66.7%) eyes. These included 2 cases of sterile corneal ulceration with prosthesis extrusion, 2 cases of microbial keratitis (1 bacterial and 1 fungal), 2 cases of bacterial endophthalmitis, and 2 cases of retinal detachments. These complications contributed to visual outcomes of hand motions in 2 eyes and no light perception in 1 eye.
Conclusions: The Boston Kpro-1 is associated with highly satisfactory visual outcomes and prosthesis retention in most cases of severe chemical or thermal injury. Serious complications are common and may compromise the final outcome.

• 出版日期2014-9