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The graft with the central hole is slid over the KPro stem.

Thus, the axial length of the individual aphakic patient is always requested from the surgeon to allow the choice of a KPro that theoretically matches the dioptric requirement of the eye to be operated.

The optical power of every KPro is determined in the machine shop at the end of manufacturing by using a microscope base mounted on an optical bench.(4) The KPro is held in a diaphragm in front of the microscope and an illuminated Air Force bar chart is placed 10 feet away.

The back plate is fully made in the Hardinge lathe, and only requires deburring, inspection, and crack testing.

Evaluation of Optics
The KPros are manufactured to match the refractive need of the individual patient and, therefore, a substantial inventory is required to rapidly supply a device of the desired dimensions.

The observer looks through the microscope at both KPro surfaces for quality evaluation.

The KPro has been incorporated into a corneal graft.

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 ().

N2 - Objective: To report the retention rate of the Boston keratoprosthesis type 1 and to identify risk factors for keratoprosthesis loss. Design: Cohort study. Participants: A total of 300 eyes of 300 patients who underwent implantation of the Boston keratoprosthesis type I device between January 2003 and July 2008 by 19 surgeons at 18 medical centers. Methods: Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site. Main Outcome Measures: Keratoprosthesis retention. Results: A total cumulative number of 422 life-years of device implantation are included in this analysis. The average duration of follow-up was 17.1±14.8 months, with a range of 1 week to >6.1 years. Ninety-three percent of the 300 Boston keratoprosthesis implants were retained at their last follow-up, corresponding to a retention time of 396 patient-years or 1.42 years/keratoprosthesis. The probability of retention after 1 year and 2 years was 94% and 89%, respectively. During the study period, 21 (7%) eyes failed to retain the device; the reasons for keratoprosthesis loss include sterile keratolysis (9), fungal infections (8), dense retroprosthetic membranes (3), and bacterial endophthalmitis (1). Multivariate analysis demonstrated 3 independent risk factors for keratoprosthesis loss: autoimmune cause (hazard ratio [HR], 11.94; 95% confidence interval [CI], 3.31-43.11), ocular surface exposure requiring a concomitant tarsorrhaphy (HR, 3.43; 95% CI, 1.05-11.22), and number of prior failed penetrating keratoplasties (HR, 1.64; 95% CI, 1.18-2.28). Conclusions: The Boston keratoprosthesis type 1 seems to be a viable option for eyes that are not candidates for penetrating keratoplasty (PK). Ocular surface disease due to an autoimmune cause demonstrated the lowest retention rate. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Boston Type 1 Keratoprosthesis: Microbial Colonization …

Objective: To report the retention rate of the Boston keratoprosthesis type 1 and to identify risk factors for keratoprosthesis loss. Design: Cohort study. Participants: A total of 300 eyes of 300 patients who underwent implantation of the Boston keratoprosthesis type I device between January 2003 and July 2008 by 19 surgeons at 18 medical centers. Methods: Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site. Main Outcome Measures: Keratoprosthesis retention. Results: A total cumulative number of 422 life-years of device implantation are included in this analysis. The average duration of follow-up was 17.1±14.8 months, with a range of 1 week to >6.1 years. Ninety-three percent of the 300 Boston keratoprosthesis implants were retained at their last follow-up, corresponding to a retention time of 396 patient-years or 1.42 years/keratoprosthesis. The probability of retention after 1 year and 2 years was 94% and 89%, respectively. During the study period, 21 (7%) eyes failed to retain the device; the reasons for keratoprosthesis loss include sterile keratolysis (9), fungal infections (8), dense retroprosthetic membranes (3), and bacterial endophthalmitis (1). Multivariate analysis demonstrated 3 independent risk factors for keratoprosthesis loss: autoimmune cause (hazard ratio [HR], 11.94; 95% confidence interval [CI], 3.31-43.11), ocular surface exposure requiring a concomitant tarsorrhaphy (HR, 3.43; 95% CI, 1.05-11.22), and number of prior failed penetrating keratoplasties (HR, 1.64; 95% CI, 1.18-2.28). Conclusions: The Boston keratoprosthesis type 1 seems to be a viable option for eyes that are not candidates for penetrating keratoplasty (PK). Ocular surface disease due to an autoimmune cause demonstrated the lowest retention rate. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

AB - Objective: To report the retention rate of the Boston keratoprosthesis type 1 and to identify risk factors for keratoprosthesis loss. Design: Cohort study. Participants: A total of 300 eyes of 300 patients who underwent implantation of the Boston keratoprosthesis type I device between January 2003 and July 2008 by 19 surgeons at 18 medical centers. Methods: Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site. Main Outcome Measures: Keratoprosthesis retention. Results: A total cumulative number of 422 life-years of device implantation are included in this analysis. The average duration of follow-up was 17.1±14.8 months, with a range of 1 week to >6.1 years. Ninety-three percent of the 300 Boston keratoprosthesis implants were retained at their last follow-up, corresponding to a retention time of 396 patient-years or 1.42 years/keratoprosthesis. The probability of retention after 1 year and 2 years was 94% and 89%, respectively. During the study period, 21 (7%) eyes failed to retain the device; the reasons for keratoprosthesis loss include sterile keratolysis (9), fungal infections (8), dense retroprosthetic membranes (3), and bacterial endophthalmitis (1). Multivariate analysis demonstrated 3 independent risk factors for keratoprosthesis loss: autoimmune cause (hazard ratio [HR], 11.94; 95% confidence interval [CI], 3.31-43.11), ocular surface exposure requiring a concomitant tarsorrhaphy (HR, 3.43; 95% CI, 1.05-11.22), and number of prior failed penetrating keratoplasties (HR, 1.64; 95% CI, 1.18-2.28). Conclusions: The Boston keratoprosthesis type 1 seems to be a viable option for eyes that are not candidates for penetrating keratoplasty (PK). Ocular surface disease due to an autoimmune cause demonstrated the lowest retention rate. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Définitions de boston keratoprosthesis, synonymes, ..


Eyelid Mass in Boston Keratoprosthesis Type 2 | Read …

KPro placement offers relatively fast visual rehabilitation. The devices are amenable for use in many situations in which other types of keratoplasty are not an option.

Boston Keratoprosthesis Type 1 Study Group - …

The machining of blanks for the two components of the KPro is performed similar to the previously described method4, now using a computerized lathe (Hardinge CHNC).

Management of glaucoma following Boston KPro consists of ..

AB - For the anterior segment surgeon, the implantation of Boston type 1 keratoprosthesis is a multistep process that begins with careful patient selection. Success depends on thorough preop­erative evaluation, detailed surgical planning, and frequent postoperative follow-up. New practice patterns have emerged for each of these phases as the international experience with keratopros­thesis grows. This review details special considerations that can improve outcomes and also allow surgeons to consider its use in challenging patient populations at each step.

Boston type 1 based keratoprosthesis (Auro Kpro) and …

The anterior surface power for the pseudophakic KPro is about 43-44 diopters.

Assembly
In the operating room, the technique of assembling the threadless KPro into a corneal graft varies from that of the previous, threaded type only in the placement of the back plate.

(1) The Boston Type I KPro is ..

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 KPro: Current And Future Directions

A retroprosthesis membrane requiring opening with YAG laser formed in only 3 eyes (one with SJS, one after pseudomonas keratitis and one after severe herpes simplex keratitis).

Boston KPro: Current And Future Directions ..

N2 - For the anterior segment surgeon, the implantation of Boston type 1 keratoprosthesis is a multistep process that begins with careful patient selection. Success depends on thorough preop­erative evaluation, detailed surgical planning, and frequent postoperative follow-up. New practice patterns have emerged for each of these phases as the international experience with keratopros­thesis grows. This review details special considerations that can improve outcomes and also allow surgeons to consider its use in challenging patient populations at each step.

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