Preliminary Study On Clinical Efficacy Of The Boston Keratoprosthesis Transplantation

Objective:The keratoprosthesis (Kpro) is a special refractive device made of theheterogeneous material implanted in the affected eye to replace the cloudy corneainorder to improve vision, keep the eyeball intact,control the infection of cornea andrecover the corneal transparency. Boston keratoprosthesis (Dohlman type)is made byHarvard University and the Massachusetts Eye and Ear Hospital,which has been usedwidely in the world,and obtain satisfactory clinical efficacy in a wide range ofcomplicated corneal diseases.My ophthalmology department screened several patientssuffering from serious corneal diseases who were given the Boston keratoprosthesistransplantation and achieve the desired effect at last. To evalate the clinical efficacy ofthe Boston keratoprosthesis transplantation and elevate the level of clinical treatment ofthe patient’s severe corneal blindness in the future,we investigate retrospectively theefficacy of the Boston keratoprosthesis transplantation in treatment of chinese patientswith corneal blindness.Methods:1.Nine Boston keratoprostheses were transplanted in nine patientswith serious bilateral or unilateral corneal blindness who were treated in the departmentof ophthalmology of Shenyang Military Region Hospital.Nine eyes from7malepatients and2female patients aged40to58years old were caused by severe acidburn(1eye),severe fungal corneal ulcer(6eyes),measles viral keratitis(1eye) andbullous keratopathy intraocular lens implantation.(1eye), Preoperative visual acuitieswere hand moving (8eyes)and light perception(1eye) whose intraocular pressure werenormal.2.Surgical methods:The Surgeries included two methods.One was Boston keratoprosthesis transplantation combined with len excision and anterior segment vitrectomy (6eyes).Theother was Boston keratoprosthesis transplantation with extracapsular lens extract andintraocular lens implantation (3eyes).3.The patients were given to wear the contact lens, steriods eye drops,antibioticeye drops and oral minocycline for a long time after the surgery.Results:1.Postoperative vision:the best corrected visual acuity:0.8(1eye),0.5(1eye),0.3(2eyes),0.2(3eyes)0.08(1eye),figure count (1eye),the Bostonkeratoprosthesis remains in place, without disposition.2: Refraction: examination with glasses showed,3eyes were normal,3eyes werehyperopic (+1.00~+3.00D),2eyes myopic (-1.00~-250D). and1eye figure countuncorrected.3. Field of view:6months after surgery, six eyes were checked with theautomated static perimetry, the visual field ranged from90°to110°,2eyes(4monthsafter surgery),1eye(no way to check.).4. Complications:(1) Retrokerotoprosthesis membranes (3eyes), with pigmented things like that ofintraocular lens surface. The3eyes were given YAG laser capsulectomy to cure.(2)One eye of after-cataract was given YAG laser capsulectomy to cure;(3)Postoperative vitreous hemorrhages (2eyes), absorbed one month after medication.(4)Retinal detachment (1eye),recovered by vitrectomy.(5) Corneal rejection(8eyes),given the cyclosporine eye drops until the rejection disappear.(6) Glaucoma (3eyes),one eye was controled by cyclophotocoagulation.The other two eyes werecontroled by antiglaucoma eye drops treatment.Conclusions:Boston keratoprosthesis transplantation is effective to a number ofpatients with high risk rejected corneas and repeated failure of corneal transplant.Thekey points of the technology are the correct choice of surgical indications, high-qualitysurgical procedures and postoperative standardized treatment. The long-term effectneeds further clinical observation.