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Ergebnisse nach Boston-Keratoprothese

Results with the Boston keratoprosthesis

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Zusammenfassung

Hintergrund

Die Boston-Keratoprothese (BKP) ist eine chirurgische Therapiemöglichkeit bei Patienten mit kornealen Erkrankungen mit schlechter Prognose für eine perforierende Keratoplastik. Wir wenden diese Operationstechnik seit November 2009 an.

Methoden

Alle zwischen 11/2009 und 8/2011 mit einer BKP Typ I versorgten Patienten wurden retrospektiv identifiziert und deren Daten ausgewertet. Die Op. und die postoperative Versorgung erfolgten nach standardisierten Empfehlungen der Entwickler der BKP.

Ergebnisse

Bei allen 14 Patienten im Alter von 36–78 Jahren lagen oberflächliche und tiefe Hornhauttrübungen vor sowie der Verlust der normalen Hornhautoberfläche (Konjunktivalisierung). In 13 Fällen wurde der Eingriff nach vorausgegangener Keratoplastik durchgeführt, einmal primär. Grunderkrankungen waren u. a. Stevens-Johnson-Syndrom, Zustand nach Verätzung oder Bulbustrauma, chronische atopische Keratitis, Keratokonus, Hornhauttrübung bei granulomatöser Uveitis, kongenitales Glaukom. Nachbeobachtet wurde 1–21 Monate lang. Postoperative Komplikationen waren z. B. Synechienbildung, Beschläge der Kunstlinse, Sekundärglaukom, Hypotonie oder Makulaödem. In allen Fällen war ein Visusanstieg zu verzeichnen.

Fazit

Bis jetzt konnten alle BKP erhalten werden. Die BKP gewinnt für uns an Stellenwert, auch in Fällen mit schlechter Voraussetzung für eine typisierte Limbus-/Hornhauttransplantation. Die Kostenerstattung der BKP muss für den Einzelfall geregelt werden.

Abstract

Background

The Boston keratoprosthesis (BKP) is a surgical therapeutic option in patients with corneal disease and poor prognosis for penetrating keratoplasty. The purpose of this study was to summarize our results with this surgical technique which we have employed at our institution since November 2009.

Methods

All patients who underwent the BKP procedure at our institution between November 2009 and August 2011 were identified retrospectively and the data were analyzed. The surgical procedure and postoperative treatment were performed following the recommendations of the developers of the BKP.

Results

A total of 14 patients were included in the study and the patient age ranged from 36 to 78 years. All patients had superficial and stromal corneal opacification with loss of the normal corneal surface (conjunctivalization). In 13 patients the BKP was implanted after at least 1 penetrating keratoplasty (including 3 matched grafts) and in 1 patient it was performed as a primary procedure. The underlying diseases were Stevens-Johnson syndrome, chemical injury, chronic atopic dermatitis in neurodermitis, keratoconus, granulomatous uveitis, congenital glaucoma and eyeball injury/burn. The follow-up ranged from 1 to 21 months. Postoperative complications consisted of prolonged inflammatory anterior chamber reaction with synechia, deposits on the intraocular lens, posterior capsule opacification, secondary glaucoma, hypotension, conjunctival growth over the keratoprosthesis and cystoid macular edema. All cases had overall improvement of visual acuity at the last follow-up visit. The maximum improvement was from counting fingers to 0.7.

Conclusion

Until now all BKPs have been preserved. At our institution the BKP is becoming increasingly more important even in such cases with a (very) poor prognosis for matched limbal and/or corneal grafts. Reimbursement for the BKP must, however be organized on a case by case basis.

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  1. Praxis Prof. Neuhann & Kollegen, Helene-Weber-Allee 19, 80637, München, Deutschland

    B. Koller, T. Neuhann & I. Neuhann

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  1. B. Koller
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  2. T. Neuhann
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  3. I. Neuhann
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Correspondence to B. Koller.

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Koller, B., Neuhann, T. & Neuhann, I. Ergebnisse nach Boston-Keratoprothese. Ophthalmologe 109, 454–461 (2012). https://doi.org/10.1007/s00347-011-2490-y

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