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Abstract #60214 Published in IGR 16-4
Predictors of visual outcomes following Boston type 1 keratoprosthesis implantation
Ahmad S; Akpek EK; Gehlbach PL; Dunlap K; Ramulu PYAmerican Journal of Ophthalmology 2015; 159: 739-747.e1
PURPOSE: To identify predictors of visual outcomes following Boston type 1 Keratoprosthesis (KPro) implantation. DESIGN: Retrospective chart review. METHODS: Data regarding preoperative clinical and demographic characteristics and postoperative course were collected. PATIENTS: Fifty-nine eyes of 59 adult patients who underwent KPro implantation between January 2006 and March 2012 at a single tertiary care center. MAIN OUTCOME MEASURES: Preoperative factors associated with all-cause and glaucoma-related loss of visual acuity from the best postoperative visual acuity noted. RESULTS: Fifty-two of 59 eyes (88%) achieved improved vision post implantation, with 7 eyes failing to gain vision as a result of pre-existing glaucoma (n = 4) or retino-choroidal disease (n = 3). Twenty-one eyes (21/52, 40%) maintained their best-ever visual acuity at last visit (mean follow-up period was 37.8 months). The likelihood of maintaining best-ever vision was 71% at 1 year, 59% at 2 years, and 48% at 3 years. Primary KPro implantation was associated with a higher likelihood of losing best-ever vision as compared to KPro implantation as a repeat corneal procedure (hazard ratio [HR] = 3.06; P = 006). The main reasons for postimplantation vision loss was glaucoma (12/31, 39%), and the risk of glaucomatous visual acuity loss was 15% at 2 years and 27% at 3 years. Prior trabeculectomy was associated with a higher rate of vision loss from glaucoma (HR = 3.25, P = .04). CONCLUSION: Glaucoma is the primary reason for loss of visual acuity after KPro implantation. Conditions necessitating primary KPro surgery are associated with more frequent all-cause vision loss. Prospective trials are necessary to better determine which clinical features best predict KPro success.
The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Full articleClassification:
9.4.11.4 Glaucomas associated with corneal surgery (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)
