Boston Type 1 Keratoprosthesis With Autologous Buccal Mucosa Overlay for Cases With Severe Ocular Surface Alterations

Abstract

Purpose: To evaluate anatomical and functional outcomes, and complications, of Boston type 1 keratoprosthesis with autologous oral mucosa graft (B1KProM) to reconstruct and protect the ocular surface of eyes with severe conditions.

Design: Retrospective interventional case series.

Methods: Data from 19 eyes of 19 patients (12 males; mean age of 61 ± 18 years) with irreversible corneal opacification (autoimmune diseases [11], chemical burns [5], or other [3]), who underwent B1KProM surgery. Anatomical success was defined as retention of the keratoprosthesis during the follow-up and functional success as postoperative best-corrected visual acuity (BCVA) ≤1.3 logMAR at the last follow-up.

Results: The median mucosal reepithelialization time was 3 weeks. Mucosal complications were poor epithelization, overgrowth, and necrosis and occurred in 14 episodes in 9 eyes (47%), all successfully managed, except in 2 eyes with concomitant extrusion. The incidence of other complications was under previously described ranges. Anatomical failure occurred in 4 of 19 cases (21%), all of them with autoimmune diseases. Cumulative probability of anatomical success was 89%, 80%, and 40% at 12, 24, and 36 months, respectively. BCVA ≥20/200 was found at some point postoperatively in 11 of 12 cases (92%) with visual potential. Cumulative probability of functional success was 89%, 78%, and 29% at 12, 24, and 36 months, respectively. The mean follow-up was of 18±12 months (range: 1-36 months).

Conclusions: B1KProM emerges as a promising option for patients with complex ocular surface conditions. Mucosal complications were frequent but manageable. Further research is essential to confirm its long-term effectiveness.