title: Long-Term Outcomes of the Boston Type I Keratoprosthesis in the Management of Corneal Limbal Stem Cell Deficiency.
abstract: OBJECTIVE
  To report the long-term outcomes of the Boston type I keratoprosthesis (KPro) in the management of limbal stem cell deficiency (LSCD).
  
  
  METHODS
  Retrospective review of KPro procedures performed by a single surgeon from May 1, 2004, to January 1, 2015.
  
  
  RESULTS
  One hundred seventy-three KPro procedures were performed in 149 eyes, including 68 in 54 eyes with LSCD. Glaucoma (48% vs. 82%, P < 0.0001) and a history of ≥2 keratoplasties (39% vs. 79%, P < 0.0001) were significantly less common in eyes with LSCD. Preoperative corrected distance visual acuity was ≥20/200 in 7% of eyes with LSCD and 9% of eyes without LSCD. A significantly greater percentage of eyes with LSCD had CDVA ≥ 20/200 at each of the first 5 years after surgery. The only postoperative complication more common in eyes with LSCD compared with eyes without was persistent corneal epithelial defect (50% vs. 28%, P = 0.013), although the associated secondary complications sterile corneal necrosis (22% vs. 11%, P = 0.059) and corneal infiltrate (20% vs. 10%, P = 0.08) were twice as common in eyes with LSCD. Despite this, the retention failure rates in eyes with and without LSCD were similar (0.089/eye-yr vs. 0.071/eye-yr; P = 0.53).
  
  
  CONCLUSIONS
  Boston type I keratoprosthesis implantation results in a significant improvement in CDVA in the majority of eyes with LSCD through 5 years after surgery, with better visual outcomes than eyes without LSCD. Although several postoperative complications are more common in LSCD, sight-threatening complications such as endophthalmitis and retinal detachment are not. Additionally, there is no difference in the retention failure rate in eyes with and without LSCD, although a larger number of procedures with longer follow-up will be needed to determine retention outcomes more than 5 years after surgery.
authors.affiliation: *Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA; and †Departamento de Oftalmología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Carolina
authors.initials: C
authors.lastname: Aravena
authors.forename: Tahir Kansu
authors.initials: TK
authors.lastname: Bozkurt
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Aldave
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001187:Artificial Organs; D001705:Bioprosthesis; D002648:Child; D003315:Cornea; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000534:rehabilitation; D014792:Visual Acuity / Q000502:physiology