​​First Two to Three Years Post-KPro Crucial to Treat Complications

Boston keratoprosthesis (KPro), a specialized keratoplasty for patients with prior graft failures or high preoperative risk of failure, plays an important role in treating complex corneal disease but is associated with many complications. In a recent study, researchers sought to address correlations and trends found in KPro patients to understand the evolution and optimize postoperative care to minimize complications. They found that younger patients are at a higher risk for specific complications and more frequently require glaucoma surgery post-KPro, and this group had a higher risk of vision-threatening complications, with more repeat KPros deemed necessary. The findings were reported in Canadian Journal of Ophthalmology. A recent study found that KPro prolongs functional vision, but close monitoring is crucial—especially within the first two to three—to detect and treat associated complications. Click image to enlarge. A total of 157 eyes of 136 patients who underwent KPro surgery between 2008 and 2022 in Montreal were included. The parameters followed included initial graft indication, age, pre-and postoperative best-corrected visual acuity (BCVA), intraocular pressure, cup-to-disc ratio, glaucoma interventions and postoperative complications.The most common indication was aniridia (26.1%), and 54% of patients having at least one prior graft failure.Long-term visual outcomes demonstrated improvement in BCVA following surgery, with nearly 50% achieving vision better than 20/200 five years postoperatively. This decreased over time to only 37.1% at 10 years and to one-third at 15 years.“A novel finding in this study was that the most significant decline in vision occurred within the first three years, then slowed, resulting in less vision loss in subsequent years,” the authors noted in their paper. Importantly, the best BCVA was significantly better than initial BCVA, indicating that patients experienced improved vision compared to baseline at some point after surgery.” However, the authors pointed out, the final BCVA was worse than the best BCVA, indicating progressive vision degradation over time.De novo glaucoma was the most common complication (63.6% of patients without prior glaucoma), followed by retroprosthetic membranes (RPM) at 46.5%, hypotony (28.7%) and cystoid macular edema (20.4%). More than two-thirds of patients retained their KPros.Patients aged 65 and younger experienced significantly more hypotony, choroidal detachments, corneal melt/necrosis and vision-threatening complications, requiring more repeat KPro surgeries. Aniridic patients also had significantly more retroprosthetic membrane development, hypotony and choroidal and retinal detachments.“The presence of aniridia alone cannot fully explain the increased complication rate, since we did not observe a higher rate of retinal detachment in our cohort,” the authors wrote in their paper. “Younger patients needing KPro may also be a sign of a more progressive and aggressive disease process, which our data may not have accounted for (e.g., a more significant penetrance of aniridia). There were also significantly more severe, vision-threatening complications in our younger population, and more necessity for repeat KPros.These findings emphasize the need for lifelong follow-up, as vision-threatening complications can arise at any time, the authors noted.“Future research should focus on developing personalized interventions and strategies to mitigate long-term complications, to assist caregivers in educating patients about their prognosis and to establish evidence-based follow-up guidelines to ensure that complications, which tend to arise at specific postoperative time points, are promptly detected and managed,” the authors concluded in their paper. Click here for the journal source. Bernstein A, Gheth Y, Nassrallah W, et al. Long-term outcomes of the Boston keratoprosthesis: a 15-year follow-up. Can J Ophthalmol. September 1, 2025. [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.