title: The Usage of a Conjunctival Flap to Improve Retention of Boston Type 1 Keratoprosthesis in Severe Ocular Surface Disease.
abstract: OBJECTIVE
  The Boston keratoprostheses type 1 devices (KPro) are utilized in cases unfavorable to penetrating keratoplasty. The prognosis remains guarded in cases of ocular surface disease due to risk of tissue necrosis. We describe a novel surgical approach using a conjunctival flap with a delayed opening to improve retention.
  
  
  METHODS
  In three patients with advanced cicatrizing conjunctivitis, a Type 1 keratoprosthesis was stabilized using a full tarsal conjunctival flap. Three months postoperatively, an opening was created in the flap overlying the optical portion of the device.
  
  
  RESULTS
  All patients had no device related complications over a mean follow-up period of 17.7 months (range 15-21 months) and vision remained excellent at better than 20/200 for all patients.
  
  
  CONCLUSIONS
  Utilization of a tarsal flap either primarily as part of a two stage modified technique or secondarily in cases of tissue necrosis and impending device extrusion might maximize retention of the type 1 KPro.
authors.affiliation: a Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Allen O
authors.initials: AO
authors.lastname: Eghrari
authors.affiliation: a Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Sumayya
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: a Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Ramulu
authors.affiliation: a Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Iliff
authors.affiliation: a Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Esen Karamursel
authors.initials: EK
authors.lastname: Akpek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001187:Artificial Organs; D001705:Bioprosthesis; D002921:Cicatrix / Q000601:surgery*; D003228:Conjunctiva / Q000601:surgery*; D003231:Conjunctivitis / Q000601:surgery*; D003315:Cornea; D005260:Female; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation; D060489:Prosthesis Retention / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps
keywords: Artificial cornea; complications; keratoprosthesis; surgical technique