Boston Keratoprosthesis Type II: Indications, Techniques, Outcomes, and Management
Implantation of a keratoprosthesis device is indicated for the visual rehabilitation of patients with corneal blindness in whom a standard corneal allograft would likely fail. The Boston keratoprosthesis type I device is a collar button-shaped device, com
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Sotiria Palioura and James Chodosh
19.1
Contents 19.1
Introduction ..............................................
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19.2
Indications ................................................
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19.3 19.3.1 19.3.2 19.3.3
Techniques ................................................ Preoperative Evaluation ............................. Surgical Technique..................................... Postoperative Care .....................................
170 170 172 173
19.4
Outcomes ..................................................
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19.5 19.5.1 19.5.2 19.5.3 19.5.4 19.5.5 19.5.6
Complication Management ..................... Glaucoma ................................................... Retroprosthetic Membrane ........................ Retinal and Choroidal Detachment ............ Infectious Endophthalmitis ........................ Tissue Necrosis, Melt, and Extrusion ........ Sterile Uveitis-Vitritis ................................
175 175 176 176 176 176 177
Concusions ..............................................................
177
References ...............................................................
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S. Palioura, MD, PhD • J. Chodosh, MD, MPH (*) Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston 02114, MA, USA e-mail: [email protected]; [email protected]
Introduction
The inception of a keratoprosthesis – a synthetic or partly synthetic cornea – for patients with corneal blindness dates more than 120 years ago [1]. Efforts toward the development of the Boston keratoprosthesis were initiated in the early 1960s by Dr. Claes H. Dohlman, and the device was approved by the US Food and Drug Administration for marketing in 1992 [2–4]. Since then, more than 7,500 devices have been implanted, rendering the Boston keratoprosthesis the most frequently implanted artificial cornea worldwide [5–8]. The type II device, a modified version of the type I designed for through-the-lid implantation, is used much less commonly than the type I (Fig. 19.1). At the Massachusetts Eye and Ear Infirmary, only 29 eyes received a Boston keratoprosthesis type II over a 10-year period (from
Fig. 19.1 Photomicrograph of the Boston keratoprosthesis type I (left) and II (right) devices
M. Soledad Cortina, J. de la Cruz (eds.), Keratoprostheses and Artificial Corneas: Fundamentals and Surgical Applications, DOI 10.1007/978-3-642-55179-6_19, © Springer-Verlag Berlin Heidelberg 2015
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S. Palioura and J. Chodosh
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January 2000 to December 2009) compared with greater than 350 that received a type I device in the same time period [9].
19.2
Indications
The Boston keratoprosthesis type I is indicated for patients with a history of repeated allograft failure, corneal opacity with extensive neovascularization, and in select cases of limbal stem cell deficiency, such as aniridia. Such patients typically have normal eyelids, blink, and tear film. In contrast, patients with severe autoimmune ocular surface diseases, such as Steve
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