Report of Descemet-Sparing Technique for Boston Type I Keratoprosthesis With Clinical Follow-Up.

Purpose: The aim of this study was to describe the long-term outcome following a modified technique of the Boston type I keratoprosthesis (KPro) placement over a period of 7 years.

Method: Deep anterior lamellar keratoplasty combined with Boston type I KPro Click-On implantation was performed in a patient with history of uveitic glaucoma, glaucoma drainage device placement, and multiple graft failures including four Descemet stripping automated endothelial keratoplasty procedures for pseudophakic bullous keratopathy followed by penetrating keratoplasty.

Result: Using this modified surgical approach, the patient's right eye vision improved from hand motion preoperatively to 20/150 on postoperative day 1. Six months later, he underwent Nd:YAG laser of an opacified central Descemet membrane, after which vision improved to 20/80 and was maintained over 7 years. No other postoperative common KPro complications occurred. A recent contact lens trial with a correction of -9D improved vision further to 20/30.

Conclusions: This modified surgical technique for placement of Boston type I KPro is less invasive compared with conventional methods and may prevent complications associated with an open-sky surgery, making it a safer alternative. Furthermore, when combined with Nd:YAG laser membranectomy of the Descemet membrane, vision can be further improved.