Artifical cornea is well-retained in patients with ocular surface disease

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1. Approximately 93% of patients retained their keratoprosthesis at the last follow-up visit. (mean duration of 17 months). 

2. Risk factors for keratoprosthesis loss are autoimmune disease (95% CI 3.31-43.11), ocular surface exposure requiring tarsorrhaphy (95% CI 1.05-11.22), number of prior failed corneal transplants (95% CI 1.18-2.28).

This study demonstrates that a high percentage of patients fitted with a Boston keratoprosthesis retain their prosthesis. The 93% retention rate is similar to the 95% retention rate found in a previous study with a shorter follow-up period (average of 8.5 months). The risk factor analysis is quite revealing, as surprisingly no comorbid ocular or systemic conditions affected retention, aside from autoimmune disease. This data is significant in demonstrating the stability of the keratoprosthesis, which is the only therapeutic option for patients who are not candidates for corneal transplants. While these findings are significant, one of the limitations is that only 30% of patients were followed for over 2 years. Nonetheless, the data demonstrate that for the majority of patients, the Boston keratoprosthesis is a reliable surgical therapy for severe ocular surface disease.

Click to read the study in Ophthalmology

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Image: PD

1. Approximately 93% of patients retained their keratoprosthesis at the last follow-up visit (average duration of 17 months). 

2. Risk factors for keratoprosthesis loss are autoimmune disease (95% CI 3.31-43.11), ocular surface exposure requiring tarsorrhaphy (95% CI 1.05-11.22), number of prior failed corneal transplants (95% CI 1.18-2.28).

This [retrospective cohort] study: This study is an analysis of keratoprosthesis retention with a significantly extended follow-up period. The Boston keratoprosthesis was implanted in patients who had significant ocular surface disease but were not candidates for a penetrating keratoplasty, also known as a corneal transplant. All patients were followed for a mean time of 17.1 months, with documentation of their disease etiology and retention status during all follow-up visits. 300 eyes with prostheses were evaluated for retention at their final visit. The retention rate was 93% among all eyes. While neither ocular (e.g., glaucoma) nor systemic disease (e.g., diabetes) were risk factors for retention, autoimmune disease had a significant role, leading to a shorter time to failure (29% of diseased patients; p<0.0001). In addition, eyes requiring tarsorrhaphy (surgical closure of the eyelids) also had a significant increase in failure (30% of such patients; p<0.0001). While the number of previous corneal transplant attempts was a significant risk factor (p=0.003), it was not possible to identify a clear cut-off number, after which failure significantly increased. The most common causes of failure were infection and tissue necrosis.

In sum: This study demonstrates that a high percentage of patients fitted with a Boston keratoprosthesis retain their prosthesis. The 93% retention rate is similar to the 95% retention rate found in a previous study with a shorter follow-up period (average of 8.5 months). The risk factor analysis is quite revealing, as surprisingly no comorbid ocular or systemic conditions affected retention, aside from autoimmune disease. This data is significant in demonstrating the stability of the keratoprosthesis, which is the only therapeutic option for patients who are not candidates for corneal transplants. While these findings are significant, one of the limitations is that only 30% of patients were followed for over 2 years. Nonetheless, the data demonstrate that for the majority of patients, the Boston keratoprosthesis is a reliable surgical therapy for severe ocular surface disease.

Click to read the study in Ophthalmology 

By Swarup Swaminathan and Andrew Bishara

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