title: Experience with Boston keratoprosthesis type 1 in the developing world.
abstract: OBJECTIVE
  To report the experience of the Federal University of São Paulo, Brazil, in performing Boston keratoprosthesis type 1 implantation in the developing world.
  
  
  METHODS
  We analyzed 30 eyes of 30 patients who underwent Boston type 1 keratoprosthesis surgery between 2008 and 2012 in a prospective interventional study. Preoperative, perioperative, and postoperative parameters were analyzed, including visual acuity (VA), keratoprosthesis stability, and postoperative complications.
  
  
  RESULTS
  Preoperative diagnoses were failed grafts in 16 eyes (53.33%), chemical injury in 10 eyes (33.33%) and Stevens-Johnson syndrome in 4 eyes (13.33%). Also, 16 eyes (53.33%) had preoperative glaucoma. Preoperative best corrected VA ranged from 20/400 to light perception. With an average follow-up of 32 months (range 1-55 months), postoperative vision improved to >20/200 in 24 eyes (80%). Postoperative VA was statistically improved compared with the preoperative measurement during all postoperative follow-ups (up to 36 months). During the follow-up period (32 months), retention of the initial keratoprosthesis was 93.3%. The incidence of retroprosthetic membrane was 26.66%. Progression of glaucoma occurred in 7 of 16 eyes (43%). Three patients experienced development of glaucoma after keratoprosthesis implantation. One eye experienced development of infectious keratitis, and 2 eyes had retinal detachment.
  
  
  CONCLUSIONS
  Performing Boston type 1 keratoprosthesis in a developing country is a viable option after multiple keratoplasty failures and conditions with a poor prognosis for keratoplasty. Our experience appears similar to major reports in the field from investigators in developed countries. Adjustments to postoperative management must be considered according to the particular location.
authors.affiliation: Federal University of São Paulo, UNIFESP, Brasil. Electronic address: laopadilha@gmail.com.
authors.forename: Lauro Augusto
authors.initials: LA
authors.lastname: de Oliveira
authors.affiliation: Federal University of São Paulo, UNIFESP, Brasil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Pedreira Magalhães
authors.affiliation: Federal University of São Paulo, UNIFESP, Brasil.
authors.forename: Flavio E
authors.initials: FE
authors.lastname: Hirai
authors.affiliation: Federal University of São Paulo, UNIFESP, Brasil.
authors.forename: Luciene Barbosa
authors.initials: LB
authors.lastname: de Sousa
mesh_terms: D000328:Adult; D021522:Bioartificial Organs; D001705:Bioprosthesis; D001938:Brazil; D003315:Cornea; D003316:Corneal Diseases / Q000601:surgery; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D014792:Visual Acuity / Q000502:physiology