Boston type 1 KPros in India ‐ Indications, contraindications and device modifications

Abstract

AbstractBoston Keratoprosthesis is the most commonly used Keratoprosthesis worldwide. It is a collar button kind of Keratoprosthesis carried on a corneal graft. The prerequisites for a type 1 Boston Keratoprosthesis include the following 1) Bilateral corneal blindness 2) Reasonably healthy posterior segment 3) Well controlled Intraocular pressure or combine a shunt surgery with the Keratoprosthesis 4) Moist eye 5) Good blink 6) Well formed fornices 7) Committed to regular follow ups and Understands the potential risk involved in the surgery The current indications for Boston type 1 Keratoprosthesis are 1) Multiple failed grafts 2) Limbal stem cell deficiency 3) Ocular burns( chemical/thermal) 4) Aniridia 5) Pediatric corneal opacities 6) Silicone oil induced keratopathy Contraindications 1) Poor /Incomplete blink 2) Severely damaged lid apparatus post chemical injuries 3) Keratinized ocular surface (would be an indication for Boston type 2/MOOKP) Design modifications like addition of more holes in the back plate, the use of the titanium locking ring, Use of a bandage contact lens and prophylaxis with antibiotics with the present design have improved the outcome and retention rates of the Keratoprosthesis. Further research in the form of a titanium back plate to reduce the rates of retroprosthetic membrane formation is being tried.