title: Corneal Melt after Boston Keratoprosthesis: Clinical Presentation, Management, Outcomes and Risk Factor Analysis.
abstract: OBJECTIVE
  To determine the presentation, risk factors, and outcomes of keratolysis after Boston type I keratoprosthesis (B-KPro).
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  A total of 16 (14%) of the 110 eyes (96 patients) which underwent B-KPro implantation developed keratolysis at an average 20 ± 11 months. Retroprosthetic membrane (RPM), infectious keratitis, and corneal dellen were identified in 31%, 25%, and 13% of corneal melts, respectively. Five eyes had keratolysis without a readily identifiable cause. RPM (odds-ratio, OR = 4.4, p = 0.02) and infectious keratitis (OR = 17.6, p<0.0005) were confirmed as significant risk factors. Retinal detachment (p = 0.001) and choroidal detachment (p = 0.003) were more common in eyes with keratolysis. Management included B-KPro removal or exchange (n = 7), amniotic membrane transplantation (n = 1), tectonic corneal transplantation (n = 2), medical treatment (n = 4), and observation (n = 2).
  
  
  CONCLUSIONS
  The risk of keratolysis following B-Kpro increases with the development of RPM and infectious keratitis. Patients with keratolysis had higher complication rates and should receive rigorous monitoring.
authors.affiliation: a Faculty of Medicine, McGill University , Montréal , Québec , Canada.
authors.forename: Soumaya
authors.initials: S
authors.lastname: Bouhout
authors.affiliation: b Department of Ophthalmology , Centre Hospitalier de l'Université de Montréal , Montréal , Québec , Canada.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Robert
authors.affiliation: c Faculty of Medicine, Université de Montréal , Montréal , Québec , Canada.
authors.forename: Sousans
authors.initials: S
authors.lastname: Deli
authors.affiliation: b Department of Ophthalmology , Centre Hospitalier de l'Université de Montréal , Montréal , Québec , Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: Harissi-Dagher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis / Q000009:adverse effects*; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D003316:Corneal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D020878:Device Removal; D019468:Disease Management; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Corneal melting; keratoprosthesis; matrix metalloproteinases; retroprosthetic membrane; sterile keratolysis