Keratoprosthesis effective in series of pediatric cases

Implantation of the Boston Keratoprosthesis appears effective as a treatment for children and infants with corneal opacities, according to a study by researchers at the University of Rochester Eye Institute in New York.

James V. Aquavella, MD, and colleagues at the university reviewed their results with implantation of keratoprostheses in 22 eyes of 17 children aged 1.5 months to 11 years. The Rochester surgeons implanted 15 children with the Boston Keratoprosthesis (K-Pro) and two children with another device, the AlphaCor artificial cornea (Addition Technology).

All children had opaque corneas due to primary congenital disease or previous failed keratoplasty. Collectively, these children had undergone more than 100 previous surgeries, including 39 failed corneal transplants, according to a press release from the University of Rochester.

"The vibrancy of a child's immune system has been one of the main reasons why cornea transplants haven't worked well in children. The risk of rejection is huge, and it just goes up with every subsequent operation," Matthew Gearinger, MD, a pediatric ophthalmologist at the university and co-investigator in the study, said in the release.

With 9.7 months mean follow-up, all 21 eyes fitted with the Boston K-Pro retained the device without dislocation or extrusion. The visual axis was clear in all eyes, although retroprosthetic membranes formed and had to be removed in five eyes. For seven verbal patients aged 4 years and older, the researchers reported visual acuities from counting fingers to 20/30. All other infants could follow light, fingers and objects, according to the study.

Neither of the two eyes fitted with the AlphaCor artificial cornea retained the device. In one eye, the prosthesis was traumatically dislocated and was replaced with a cadaver cornea. In the second eye, the implant began to extrude and was replaced with a Boston K-Pro, according to the study.

There were no reports of surface infection or endophthalmitis, and IOP was controlled in all cases, according to the study.

"These are children for whom, until now, there really has not been a good option. While this study is somewhat small and these children need to be followed for more time, we have decided that for now this is the treatment of choice for children who have corneas that are cloudy or opaque. It's either do this, or do nothing," Dr. Aquavella said in the release.

The study was presented by at the American Academy of Ophthalmology meeting in Las Vegas by Dr. Gearinger, and will be published in an upcoming issue of Ophthalmology, according to a University of Rochester representative.