Boston type I keratoprosthesis versus penetrating keratoplasty following a single failed corneal graft

• Published in: Eye (London) Vol. 37; no. 3; pp. 486 - 491
• Main Authors: El-Khoury, Jonathan, Khair, Diana, Daoud, Roy, Thompson, Paul, Racine, Louis, Harissi-Dagher, Mona
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2023; Nature Publishing Group
• Subjects: 692/308/409; 692/700/565/545/576; Acuity; Artificial Organs - adverse effects; Complications; Cornea; Cornea - surgery; Corneal Diseases - surgery; Corneal transplantation; Eye surgery; Glaucoma; Glaucoma - surgery; Graft rejection; Graft-versus-host reaction; Grafts; Humans; Keratoconus; Keratoconus - surgery; Keratoplasty, Penetrating - methods; Laboratory Medicine; Medicine; Medicine & Public Health; Ophthalmology; Pharmaceutical Sciences/Technology; Postoperative; Postoperative Complications - etiology; Prostheses and Implants; Prosthesis Implantation; Retrospective Studies; Surgery; Surgical Oncology; Visual Acuity
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/s41433-022-01969-9

Background/objectives To compare long-term outcomes of the Boston type 1 keratoprosthesis (KPro) with penetrating keratoplasty (PKP) in patients with a failed first PKP. Subjects/Methods In this retrospective comparative case series, 48 eyes of 48 patients who underwent a second corneal replacement procedure after a first failed PKP at the Centre Hospitalier de l’Université de Montréal from 2008 to 2020 were included. Minimum follow-up duration was 5 years, and patients with keratoconus were excluded since such subjects are not candidates for KPro. Main outcome measures included best-corrected visual acuity (BCVA), postoperative complications, graft survival and subsequent interventions. Results Mean follow-up was 6.4 years for PKP and 9.6 years for KPro ( p  < 0.001). Preoperative BCVA was better in PKP patients (means 1.67 vs 2.13, p  = 0.041). Visual outcomes were similar between groups. KPro patients developed 0.263 complication per patient-year (ppy) compared to 0.245 ppy or PKP. The most common complications for PKP were corneal complications (0.088 ppy) and glaucoma worsening (0.041 ppy). In KPro, glaucoma worsening (0.046 ppy), vitreoretinal complications (0.042 ppy) and retroprosthetic membrane (0.042 ppy) were the most frequent. Graft failure (69.6 vs 20.0%, p  < 0.001) and reoperation rates (56.5 vs 12.0%, p  = 0.001) were significantly higher for PKP. Failure mainly resulted from decompensation or rejection in PKP, while all five failures in KPro were caused by melt and/or extrusion. Conclusions Both interventions showed similar visual outcomes. Complication profiles were different, with more posterior segment complications in the KPro group, and more corneal complications in the PKP group, often necessitating regraft.