Eyes with severe ocular surface disease at risk for KPro-related melt complications

Patients with severe ocular surface disease who underwent implantation of a Boston type 1 keratoprosthesis had a greater risk of developing corneal melts, leaks and extrusions, according to a study.

The retrospective study included 128 eyes of 110 patients who underwent Boston type 1 keratoprosthesis (KPro) implantation at the Cincinnati Eye Institute between 2004 and 2010. Mean follow-up time was 29 months.

Twenty eyes (16%) of 18 patients developed KPro-related melt complications that required surgery, of which seven eyes had multiple episodes. A total of 33 episodes of melt-related complications occurred.

Melt-related complications occurred at a mean time of 13 months after KPro implantation. Mean time to a melt complication was 11 months in patients with conjunctival deficiency and 16 months in patients without conjunctival deficiency.

Most melt-related complications were managed by performing a lamellar corneal patch grafting technique. Other repairs included KPro removal with penetrating keratoplasty, KPro removal with reassembly onto a new cornea for implantation, KPro removal with a replacement KPro, suture closure of the leak and enucleation. Eighteen of the eyes did not regain their best KPro vision.

Previous infectious keratitis (P < .0001) and conjunctival deficiency such as Stevens-Johnson syndrome, mucous membrane pemphigoid or chemical injury (P = .043) were significant risk factors for melt.

“Because of the increased complication rate in severe ocular surface disease, we prefer an ocular surface stem cell transplant as a primary procedure if at all possible especially in younger patients,” the study authors said. “A KPro as a secondary procedure can always be performed if the former procedure fails.” – by Nhu Te

Disclosure: Chan reports she has received honoraria from Allergan, Bausch + Lomb, and Alcon Laboratories. See the full study for all other authors’ relevant financial disclosures.

Published by:

Sources/Disclosures

Collapse

Source:

Chan CC, et al. Cornea. 2016;doi:10.1097/ICO.0000000000000911.