Original article
The Boston Keratoprosthesis in Stevens-Johnson Syndrome

https://doi.org/10.1016/j.ajo.2007.11.002Get rights and content

Purpose

To evaluate the use of the Boston keratoprosthesis (KPro) in patients with Stevens-Johnson syndrome (SJS).

Design

Retrospective, noncomparative, interventional case series.

Methods

Sixteen eyes of 15 patients with SJS underwent KPro surgery at the Massachusetts Eye and Ear Infirmary from January 2000 through December 2005. The preoperative, operative, and postoperative findings were recorded. All patients underwent either the type I or type II Boston KPro surgery by one surgeon (C.H.D.). Retention of the prosthesis, best-corrected visual acuity, the need for surgical revision, and postoperative complications were recorded. The outcomes were compared with those of an earlier group of patients from the 1990s.

Results

The mean age of patients was 50 ± 18 years (range, 23 to 74 years), and the mean duration of their disease was 10 ± 6.6 years. The mean follow-up period was 3.6 ± 1.5 years (range, 10.2 months to 5.6 years). Ten eyes underwent type II KPro surgery, whereas six eyes underwent type I KPro surgery. Twelve eyes (75%) achieved a visual acuity of 20/200 or better after surgery, with eight eyes (50%) achieving excellent vision of 20/40 or better. Visual acuity was maintained at 20/200 or better over a mean period of 2.5 ± 2.0 years. Preexisting glaucoma was found to be a significant risk factor for visual loss. There were no cases of KPro extrusion or endophthalmitis.

Conclusions

KPro in SJS has improved, largely because of the introduction of vancomycin prophylaxis and better glaucoma treatment. It seems to be superior to standard penetrating keratoplasty, with or without allografted stem cell transplantation, as judged from the literature. However, the outcome of the KPro in SJS is still substantially less favorable than in nonautoimmune diseases.

Section snippets

Methods

We reviewed all patients who underwent Boston KPro implantation from January 2000 through December 2005 at the Massachusetts Eye and Ear Infirmary. A total of 154 patients had undergone KPro surgery for complicated corneal disease or repeated failed corneal grafts. Among these patients, 16 eyes of 15 patients had a basic cause of SJS, and the charts of these patients were reviewed retrospectively. All patients were operated on by the same surgeon (C.H.D.). The symptomatology, best

Results

Sixteen eyes of 15 patients with SJS who underwent KPro surgery were studied. All but one patient had a severe form of SJS. One patient had the diagnosis of toxic epidermal necrolysis. Four patients were male and 11 were female. The mean age was 50 ± 18 years (range, 23 to 74 years), and the mean duration of their disease was 10 ± 6.6 years (range, two to 20 years). Nine eyes (56%) had previous failed penetrating keratoplasties, with four having three or more. Three had undergone limbal cell

Discussion

Stevens-Johnson syndrome is a rare autoimmune disease which may lead to significant corneal changes and conjunctival scarring. It remains the worst prognostic category for KPro surgery. The prolonged severe inflammation associated with the disease makes the tissue around the KPro vulnerable to necrosis and melting, which can result in leakage, choroidals, and retinal detachment. Infection, in the form of endophthalmitis, also was a major concern in previous years.13 Yaghouti and associates

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