Boston K-Pro retention in Stevens-Johnson syndrome can be improved

The most common indication for the Boston type 1 keratoprosthesis (Boston K-Pro) in most published series is repeat corneal transplant failure. Although the Boston K-Pro has been used for a wide variety of indications, some, such as Stevens-Johnson syndrome, are associated with less favorable outcomes, limiting the number of procedures performed. Complications after Boston K-Pro implantation in patients with cicatrizing conjunctivitis usually result from donor corneal stromal necrosis. Thus, we have modified our surgical technique when performing the Boston K-Pro in patients with cicatrizing conjunctivitis to cover the donor cornea at the time of surgery as opposed to doing so after a persistent epithelial defect and secondary stromal necrosis have developed. This has resulted in improved retention of the Boston K-Pro and prolongation of improved vision. At present, the Boston K-Pro is retained in 70% of the eyes of patients with Stevens-Johnson syndrome, with corrected distance visual acuity better than 20/200 in 86% of eyes at an average follow-up of 17.3 months (range: 7.1 to 59.5 months). We attribute much of this success to the proactive performance of tarsorrhaphies and conjunctival rearrangement procedures at the time of Boston K-Pro implantation or early in the postoperative period.