title: Boston type 1 keratoprosthesis for failed keratoplasty.
abstract: The purpose of this study was to evaluate the outcomes of the Boston type 1 keratoprosthesis (Kpro-1) in eyes with failed keratoplasty. A retrospective review was performed of every patient treated with a Kpro-1 at a tertiary eye care center between January 1, 2008 and July 1, 2013. Eyes with a failed keratoplasty originally performed for corneal edema, trauma, or keratoconus were included in the statistical analysis. The main outcome measures were visual outcome, prosthesis retention, and postoperative complications. Twenty-four eyes met the inclusion criteria, including 13 eyes with corneal edema, 8 eyes with trauma, and 3 eyes with keratoconus. After a mean follow-up period of 28.9 months (range 7-63 months), the median best corrected visual acuity (BCVA) was 20/125. The BCVA was ≥ 20/40 in 4 (16.7 %) eyes, ≥ 20/70 in 9 (37.5 %) eyes, and ≥ 20/200 in 14 (58.3 %) eyes. Overall, the postoperative BCVA improved in 17 (70.9 %) eyes, was unchanged in 3 (12.5 %) eyes, and was worse in 4 (16.7 %) eyes. The initial Kpro-1 was retained in 22 (91.7 %) eyes, and was successfully repeated in the other 2 eyes. One or more serious prosthesis- or sight-threatening complications occurred in 8 (33.3 %) eyes. These included 1 case of wound dehiscence leading to prosthesis extrusion, 1 case of fungal keratitis leading to prosthesis extrusion, 4 cases of endophthalmitis, and 5 retinal detachments. The Boston Kpro-1 is associated with an excellent prognosis for prosthesis retention and satisfactory visual improvement in eyes with previous failed keratoplasty.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.|Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Hager
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.|Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Phillips
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.|Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Goins
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.|Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Kitzmann
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.|Cornea Research Center, Stephen A Wynn Institute for Vision Research, 375 Newton Road, Iowa City, IA, 52242-1091, USA.|Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greiner
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dean McGee Eye Institute, University of Oklahoma School of Medicine, Oklahoma City, OK, USA.
authors.forename: Alex W
authors.initials: AW
authors.lastname: Cohen
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.|Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Welder
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA. michael-wagoner@uiowa.edu.|Cornea Research Center, Stephen A Wynn Institute for Vision Research, 375 Newton Road, Iowa City, IA, 52242-1091, USA. michael-wagoner@uiowa.edu.|Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA. michael-wagoner@uiowa.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wagoner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001187:Artificial Organs; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012163:Retinal Detachment / Q000601:surgery; D012189:Retrospective Studies; D017211:Treatment Failure; D014792:Visual Acuity / Q000502:physiology
keywords: Corneal edema; Graft failure; Keratoconus; Keratoprosthesis; Ocular trauma; Penetrating keratoplasty