Improving management and outcomes of the Boston type 1 keratoprosthesis: lessons learned from available evidence

Background/aimsTo evaluate the time needed for patients with Boston type 1 keratoprosthesis (KPro) to reach their best-corrected visual acuity (BCVA) and all contributing factors.MethodsWe retrospectively reviewed 137 consecutive eyes from 118 patients, measured how long they needed to reach their BCVA and looked at factors that might affect this time duration including patient demographics, ocular comorbidities and postoperative complications.ResultsThe mean follow-up was 5.49 years. The median time to BCVA postoperatively was 6 months, with 47% of patients achieving their BCVA by 3 months. The mean best achieved logMAR visual acuity was 0.71, representing a gain of 6 lines on the Snellen visual acuity chart. Postoperative glaucoma, retroprosthetic membrane (RPM) and endophthalmitis prolonged this duration. We found no correlation between the following factors and time to BCVA: gender, age, indication for KPro surgery, primary versus secondary KPro, number of previous penetrating keratoplasties, previous retinal surgery, intraoperative anterior vitrectomy and preoperative glaucoma.ConclusionIn our retrospective cohort, the majority of subjects reached their BCVA between 3 and 6 months after KPro implantation. This duration was significantly prolonged by the development of postoperative glaucoma, RPM and endophthalmitis.

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Continuous Contact Lens Wear in Boston Type 1 Keratoprosthesis: Why Are We Still Debating?

Eye & Contact Lens Science & Clinical Practice ◽

10.1097/icl.0000000000000790 ◽

2021 ◽

Vol 47 (5) ◽

pp. 233-234

Author(s):

Maria S. Cortina

Keyword(s):

Contact Lens ◽

Continuous Contact ◽

Contact Lens Wear ◽

Boston Type 1 Keratoprosthesis ◽

Lens Wear

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Corneal Surgeries

10.4018/978-1-7998-6937-5.ch013 ◽

2022 ◽

pp. 439-503

Keyword(s):

Excimer Laser ◽

Corneal Transplantation ◽

Previous Infection ◽

Boston Type 1 Keratoprosthesis

This chapter includes corneal surgeries performed in the center such as corneal transplantation (PK, DALK, DSAEK, DMEK) with all possible complications: graft rejections, recurrence of previous diseases, reactivation of previous infection, and other rare complications. Photos of conjunctival limbal autotransplantation, Boston type 1 keratoprosthesis surgery, and corneal tattooing are included as well. Some interesting cases are discussed with management. Several possible complications after excimer laser procedures are also presented.

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Lessons Learned From Those with Long-Term Type 1 Diabetes

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2018.08.187 ◽

2018 ◽

Vol 42 (5) ◽

pp. S60-S61

Author(s):

Donna Epp ◽

Sonya Grypma ◽

Barbara Astle

Keyword(s):

Type 1 Diabetes ◽

Lessons Learned ◽

Term Type

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Clinical trial design in neurofibromatosis type 1 as a model for other tumor predisposition syndromes

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa017 ◽

2020 ◽

Vol 2 (Supplement_1) ◽

pp. i134-i140

Author(s):

Andrea M Gross ◽

Brigitte C Widemann

Keyword(s):

Clinical Trials ◽

Neurofibromatosis Type 1 ◽

Clinical Trial Design ◽

Neurofibromatosis Type ◽

Lessons Learned ◽

Benign Tumors ◽

Pediatric Cancer Patients ◽

Patient Reported ◽

Trial Endpoints

Abstract Up to 10% of all pediatric cancer patients may have an underlying germline mutation which predisposed them to develop a malignancy. With more patients being tested for and diagnosed with genetic tumor predisposition syndromes, there has been improved characterization of their many nonmalignant manifestations. However, designing and implementing clinical trials to treat the nonmalignant tumor and non-tumor manifestations of these syndromes poses many unique challenges. Unlike trials for malignancies where tumor response and survival can be used as straightforward trial endpoints, the nonmalignant manifestations are often chronic, evolve more slowly over time, and may not be immediately life-threatening. Therefore, they will likely require a different approach to both testing and treatment with a focus on more functional and patient-reported outcome trial endpoints. The recent success of treatment trials for the benign tumors plexiform neurofibromas in the tumor predisposition syndrome neurofibromatosis type 1 (NF1) can be used as a model for the development of clinical trials in other tumor predisposition syndromes. In this article, we review the unique challenges associated with targeting the nonmalignant aspects of these conditions as well as some of the lessons learned from the NF1 experience which may be applied to other syndromes in the future.

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