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Boston Keratoprosthesis (KPro) - EyeWiki

In 2014, Srikumaran et al reported mean follow-up of 46.7 months (range, 6 weeks to 8.7 years) for 139 eyes of 133 patients who had received a Boston KPro at 1 of 5 tertiary referral centers in the United States. Twenty-seven percent of eyes underwent a primary KPro procedure while 73% had a prior donor graft failure. Postoperatively, visual acuity improved to at least 20/200 in 70% of eyes. The probability of maintaining visual acuity of at least 20/200 was 50%, and device retention was estimated at 67% at 7 years. The 7-year cumulative incidence of complications was 49.7% for retroprosthetic membrane formation, 21.6% for glaucoma surgery, 18.6% for retinal detachment, and 15.5% for endophthalmitis.

Timing of Glaucoma Drainage Device With Boston KPro Surgery (GDD-KPro)

There is no Medicare national coverage policy. Medicare has established an Ambulatory Payment Classification 0293 for level V anterior segment eye procedures that includes CPT code 65770 (keratoprosthesis) and a HCPCS code for the prosthesis (C1818 - integrated keratoprosthesis OR L8609 - artificial cornea).21

An alternate treatment is the Boston Keratoprosthesis (Kpro) ..

Boston Keratoprosthesis, Type I - YouTube

Section Summary: Boston Keratoprosthesis
Numerous case series and systematic reviews of these series have assessed thousands of eyes implanted with the KPro device. A 2015 systematic review of KPro efficacy included 22 series with a total of 2176 eyes. Studies with longer follow-up (ie, at least 2 years) have shown improved visual outcomes in a substantial percentage of patients with Boston KPro. This procedure is high risk and is associated with numerous complications (eg, growth of retroprosthetic membranes) and a probable need for additional surgery, thus careful patient selection is important.

A 2012 prospective series of 265 eyes (265 patients) from 18 medical centers, published by the Boston Type 1 Keratoprosthesis Study Group, focused on the time to development of retroprosthetic membranes. Most eyes (85.4%) had undergone an average of 2.2 (range, 1-8) PKs before keratoprosthesis implantation. The remaining eyes (14.6%) were considered at high risk for PK failure and had received a primary keratoprosthesis. At a mean follow-up of 17.8 months, retroprosthetic membranes had formed in 31.7% of eyes. The mean time to development of retroprosthetic membranes was 216.7 days (range, 7 days to 4 years). Risk factors were the indication for the keratoprosthesis, specifically, infectious keratitis had a hazard ratio of 3.2 (95% CI, 1.7 to 6.2) and aniridia had a hazard ratio of 3.1 (95% CI, 1.1 to 8.9).

Boston Keratoprosthesis Type 1 - Ophthalmology

The Boston Type I Keratopros­thesis (BI-KPro) is an artificial cornea device

Lee, W., Shtein, R., Kaufman, S., Deng, S., and Rosenblatt, M. (2015). Boston keratoprosthesis: outcomes and complications: a report by the American Academy of Ophthalmology. , 122 (7), 1504-1511. Abstract retrieved July 9, 2015 from PubMed database.

Srikumaran, D., Munoz, B., Aldave, A.J., Aquavella, J.V., Hannush, S.B., Schultze, R., et al. (2014). Long-term outcomes of Boston type 1 keratoprosthesis implantation: a retrospective multicenter cohort. , 121 (11), 2159-2164. Abstract retrieved July 10, 2015 from PubMed database.

See all References The Boston Keratoprosthesis type 1 (B-KPro), ..
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the Boston keratoprosthesis type 1 (KPro)

Keratoprosthesis implantation is a procedure that involves full-thickness removal of the cornea and replacement by an artificial cornea. The Boston Type I Keratoprosthesis is currently the most commonly used keratoprosthesis device in the US. It consists of a clear plastic polymethylmethacrylate (PMMA) optic and back plate sandwiched around a corneal graft and secured with a titanium locking ring (Figure 15). After the device is assembled, a partial-thickness trephination is performed on the host cornea. Full-thickness resection of the patient's cornea is then completed using curved corneal scissors. The keratoprosthesis is then secured to host tissue using interrupted or running sutures. Generally, patients who have a history of multiple failed PKs are candidates for a keratoprosthesis transplant. Other indications include severe keratitis or ocular surface disease resulting from limbal stem cell failure, such as (Figure 16), , (Figure 17) and chemical injury (, ). The Boston Type II Keratoprosthesis is a similar device with a longer optic designed to extend through an opening made in the upper eyelid (Figure 19). It is indicated for the most severe cicatrizing ocular surface diseases.

Boston keratoprosthesis type 1 device leak.

Congenital aniridia is a hereditary disease most commonly with autosomal dominant inheritance. These slit lamp photographs of a 12-year-old with congenital aniridia (Fig. 1 A, B) show conjunctivalization of the left cornea due to stem cell deficiency and a central corneal scar. There is iris hypoplasia in both eyes. The patient has a congenital cataract in the right eye and is aphakic in the left eye after having undergone cataract surgery. The cataract and corneal scars are more easily demonstrated on retroillumination. Also note the visible inferior border of the crystalline lens and zonules in the right eye, a feature not visible in individuals with normal irides. The lower photos (Fig. 2) show the appearance of the left eye after placement of a Boston Keratoprosthesis (KPro). Please see the for more information about congenital aniridia.

Boston keratoprosthesis type 1 device leak

There is significant long-term risk of complications for those with a keratoprosthesis. Because the KPro is a foreign body, there is risk of infection or extrusion of the device. Post-operative glaucoma is common and intraocular pressure is difficult to evaluate as the hard optic makes traditional tonometry impossible. For this reason, glaucoma tube shunts are typically placed at the time of the corneal transplant at the University of Iowa. The is currently the preferred way to measure intraocular pressure in these patients in our institution. Patients can form retroprosthetic membranes requiring treatment with a Nd:YAG laser or surgical membranectomy ().

The Boston Keratoprosthesis Type II: The Massachusetts …

Ahmad, S., Akpek, E.K., Gehlbach, P.L., Dunlap, K., & Ramulu, P.Y. (2015). Predictors of visual outcomes following Boston type 1 keratoprosthesis implantation. , 159 (4), 739-747. Abstract retrieved July 9, 2015 from PubMed database.

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