Long-term outcomes of the Boston keratoprosthesis: a 15-year follow-up.

Objective: Boston keratoprosthesis (KPro) plays an important role in treating complex corneal disease but is associated with many complications. This study addresses correlations and trends found in KPro patients, to understand the evolution and optimize postoperative care to minimize complications.

Design: A retrospective case series analyzing outcomes and evolution over 15 years.

Participants: 157 eyes of 136 patients who underwent KPro surgery between 2008 and 2022 in Montreal, Quebec.

Methods: Mean follow-up of 8.44 ± 4.70 years. Parameters followed included initial graft indication, age, pre-and-post-operative best corrected visual acuity (BCVA), intraocular pressure, cup-to-disc ratio, glaucoma interventions, and postoperative complications.

Results: Aniridia was the most common initial graft indication. Fifty-four percent of patients had at least one prior graft failure. The most significant decrease in vision occurred in the first 3 years, followed by a gradual decrease, with 33% of patients retaining BCVA better than 20/200 by 15 years. The best BCVA was significantly better than the initial BCVA. Panocular conditions, such as aniridia, showed quicker visual decline than purely anterior segment pathologies. Retroprosthetic membranes, hypotony, and cystoid macular edema are common complications. Certain complications were seen to be significantly more prevalent in younger populations, although visual acuity and de novo glaucoma development did not differ significantly with age. De novo glaucoma occurred in 63.64%, diagnosed most frequently in the first 2-3 years, with one-third of patients requiring surgical intervention.

Conclusions: KPro offers a prolongation of functional vision, but patients must be monitored closely to detect and treat associated complications, especially in the first 5 years postoperatively.