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Boston keratoprosthesis complication rate high in children
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Boston type 1 keratoprosthesis implantation in children was associated with a high complication rate, device failure and poor visual outcome in a retrospective case series generated at three tertiary referral centers in Canada.
The study included 11 eyes of 11 patients aged 16 years or younger who underwent KPro implantation between January 2010 and November 2014. Five eyes were operated on after prior donor graft failure, while in the other six KPro implantations were performed as a primary procedure. The primary diagnoses were Peters anomaly type II, aniridia and sclerocornea. All eyes had a history of glaucoma. Preoperative visual acuity ranged from 20/600 to light perception.
Visual acuity after KPro implantation showed early improvement in six eyes, but deteriorated to worse than preoperative level later in the follow-up. Five eyes lost light perception and two eyes became phthisical. The outcomes did not differ between eyes that had or had not undergone previous keratoplasty.
All eyes developed severe complications, including formation of retroprosthetic membrane, sterile corneal melt and retinal detachment. Infectious keratitis led to the development of endophthalmitis in three eyes. Exacerbation of preexisting glaucoma occurred in three eyes. Only four KPro devices were retained at the end of the follow-up.
“Despite diligent postoperative care, much higher incidences of severe complications and serious sight loss were observed in our cohort compared with those reported in adult literature,” the authors noted.
In the face of cumulative evidence, the authors do not recommend KPro implantation in the pediatric population, and all three centers involved have ceased offering this option for children. – by Michela Cimberle
Disclosure: The authors report no conflict of interest
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