The long-term prognosis of Boston type I keratoprosthesis reimplantation - 5568
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Author’s Disclosure Block: Emma Youhnovska, none; Mai Katbe, none; Wissam B. Nassrallah, none; Andre Pollmann, none; Fady Sedarous, none; Rayan Tolba, none; Dominique Geoffrion, none; Mona Harissi-Dagher, none
Abstract Body
Purpose: The Boston Type I Keratoprosthesis (KPro1) is a synthetic cornea designed to restore vision in cases of corneal blindness. While KPro1 can achieve visual acuity better than 20/200, it carries a risk of failure. However, reimplantation of a second KPro1 offers another opportunity at vision restoration. This study aims to evaluate the long-term outcomes of patients undergoing a second KPro1 implantation following the failure of the initial implant. Study Design: Retrospective cohort study Methods: This retrospective study analyzed data from 18 patients (selected from a database of 140 KPro1 patients) who underwent two KPro1 implantations in the same eye, with an average follow-up period of 8.82 ± 2.49 years. The inclusion criteria required patients to be over 18 years old and to have received a second KPro1 implant in the same eye following the failure of the initial implant. The intervention examined was the second KPro1 implantation, with the primary outcome measures being the retention rate of the implant and the visual acuity at the last follow-up. An implant was considered non-retained if it was removed, extruded, or if the eye was lost. Results: Within the patient cohort that had a second KPro1, the failure rates of the second KPro1 (11.11% at 5 years) was significantly less than that of the first KPro1 (88.89% at 5 years) (p-value < 0.0001). When compared with all patients that had at least 1 KPro1, the failure rates were similar between first and second KPro1 (p-value 0.0820). Visual acuity better than 20/200 was achieved by 30.09% of patients at 3 years and 24.07% at 6 years post-second KPro1, reflecting a similar trend observed during the first KPro1 implantation. Although the rates of phthisis were higher during the second KPro1, rates of endophthalmitis, corneal melt, and extrusions were lower compared to the first KPro1. Overall, visual acuity was improved after second KPro1 except for patients that developed phthisis who did not experience any improvement at follow-ups after reimplantation. Conclusion: KPro1 reimplantation provides an opportunity to restore vision better than 20/200 following the failure of the first KPro1. Future studies with larger cohorts will help to further elucidate the long-term outcomes benefits and risks associated with KPro1 reimplantation.
