This article is more than 5 years old. Information may no longer be current.
Boston K-Pro retention in Stevens-Johnson syndrome can be improved
Click Here to Manage Email Alerts
The most common indication for the Boston type 1 keratoprosthesis (Boston K-Pro) in most published series is repeat corneal transplant failure. Although the Boston K-Pro has been used for a wide variety of indications, some, such as Stevens-Johnson syndrome, are associated with less favorable outcomes, limiting the number of procedures performed. Complications after Boston K-Pro implantation in patients with cicatrizing conjunctivitis usually result from donor corneal stromal necrosis.
Thus, we have modified our surgical technique when performing the Boston K-Pro in patients with cicatrizing conjunctivitis to cover the donor cornea at the time of surgery as opposed to doing so after a persistent epithelial defect and secondary stromal necrosis have developed. This has resulted in improved retention of the Boston K-Pro and prolongation of improved vision. At present, the Boston K-Pro is retained in 70% of the eyes of patients with Stevens-Johnson syndrome, with corrected distance visual acuity better than 20/200 in 86% of eyes at an average follow-up of 17.3 months (range: 7.1 to 59.5 months). We attribute much of this success to the proactive performance of tarsorrhaphies and conjunctival rearrangement procedures at the time of Boston K-Pro implantation or early in the postoperative period.
Thomas “TJ” John
OSN Surgical Maneuvers Editor
We have adopted a strategy of performing near complete medial and lateral posterior lamella-sparing tarsorrhaphies at the time of Boston K-Pro surgery. With such extensive closure of the eyelids, resulting in only the optic of the Boston K-Pro being visible, bandage contact lenses are not used because the lens would not be able to be replaced. Despite this aggressive management, a significant percentage of these eyes may develop a persistent corneal epithelial defect with or without secondary sterile corneal stromal necrosis.
Click here to read the full publication exclusive, Surgical Maneuvers, from the Sept. 10, 2014 Ocular Surgery News U.S. Edition, by Jamie K. Alexander, MD, Dan B. Rootman, MD, and Anthony J. Aldave, MD.