title: Boston Type 1 Keratoprosthesis: Visual Outcomes, Device Retention, and Complications.
abstract: OBJECTIVE
  To determine the visual outcomes, device retention, and complications after Boston type 1 keratoprosthesis (KPro-1) device implantation.
  
  
  METHODS
  Comprehensive review of every case of KPro-1 implantation at a tertiary eye care center.
  
  
  RESULTS
  The initial KPro-1 procedure, performed in 75 eyes without a previous keratoprosthesis, was included in the analysis. During the first 6 postoperative months, improvement occurred in the mean preoperative best-corrected visual acuity of 20/1265 to a mean best-obtained postoperative visual acuity of 20/97 (P < 0.001). After a mean follow-up period of 41.4 months (range, 0.8-82.8 months), the final mean best-corrected visual acuity was 20/428. Improved vision was recorded in 43 eyes (57.3%), ambulatory vision (≥20/400) in 47 eyes (62.7%), intermediate functional vision (≥20/80) in 23 eyes (30.7%), and full functional vision (≥20/40) in 11 eyes (14.7%). The initial device was retained in 64 eyes (85.3%), with a Kaplan-Meier retention probability of 96% at 6 months and 82% at 5 years. One or more sight-threatening complications occurred in 51 eyes (68%). These included device extrusion in 11 eyes (14.7%), ulcerative keratitis in 12 eyes (16%), endophthalmitis in 7 eyes (9.3%), sterile vitritis in 3 eyes (4%), retroprosthetic membranes in 25 eyes (33.3%), maculopathy in 26 eyes (34.7%), retinal detachment in 9 eyes (12%), and progressive optic neuropathy in 7 eyes (9.3%).
  
  
  CONCLUSIONS
  Boston KPro-1 implantation is associated with satisfactory visual outcomes and excellent device retention in a majority of cases. However, serious postoperative complications are common and may compromise the final visual result.
authors.affiliation: *Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, Iowa City, IA; †Cornea Research Center, Stephen A. Wynn Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA; and ‡Department of Management Services, Tippie College of Business, Iowa City, IA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Goins
authors.forename: Anna S
authors.initials: AS
authors.lastname: Kitzmann
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greiner
authors.forename: Young H
authors.initials: YH
authors.lastname: Kwon
authors.forename: Wallace L M
authors.initials: WL
authors.lastname: Alward
authors.forename: Johannes
authors.initials: J
authors.lastname: Ledolter
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wagoner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001187:Artificial Organs; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D003315:Cornea; D003316:Corneal Diseases / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology