Boston Type 1 Keratoprosthesis Patients Face High Glaucoma Rates After Surgery

The Boston Keratoprosthesis (KPro) artificial cornea can restore vision in patients with severe corneal blindness who are not candidates for traditional corneal transplants but its high rate of complications warrants close monitoring. Photo:  Brandon Ayres, MD. Click image to enlarge. A meta-analysis of previous studies published in American Journal of Ophthalmology found that glaucoma developed or worsened in about one-quarter to one-third of eyes after Boston Type 1 keratoprosthesis implantation.Researchers reviewed 23 observational studies from three virtual databases involving 1,482 eyes that underwent Boston Type 1 keratoprosthesis (KPro) surgery for severe corneal blindness. The review included 13 case series, nine cohort studies and one case-control study, with no randomized controlled trials identified, all of which the researchers described in their paper as “primarily glaucoma related.” Mean patient age was 54.5 years, and average follow-up lasted 39.4 months. Among 1,402 patients with available demographic data, 60.8% were male and 34.7% were female.The researchers obtained data through three virtual databases and found that 45.9% of eyes already had glaucoma before surgery. While they were unable to verify the occurrence of patient surgeries in-person, they identified several signs of surgery, including “ocular trauma, multiple graft failures, autoimmune diseases, limbal stem cell deficiency, corneal neovascularization and aniridia.” In addition, “the pooled incidence of any form of postoperative glaucoma events was 25.6%,” while de novo glaucoma developed in 31.1% of eyes and pre-existing glaucoma progressed in 37.7%. Ocular hypertension without confirmed glaucoma occurred in 17.1% of eyes.The authors noted that “glaucoma remains a significant sight threatening post-operative complication” despite improvements in KPro design and in postoperative care practices. They also reported that glaucoma events were most common during the first two years after surgery, encouraging “vigilant perioperative monitoring and standardized diagnostic approaches” for future patients who experience further problems after receiving the KPro implant.Click here for the journal source. Abu Osba A, Sawires K, Bondok M, et al. Incidence and progression of glaucoma following Boston Type 1 Keratoprosthesis: a systematic review and meta-analysis. May 20, 2026. [Epub ahead of print].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.