Boston Type 1 Keratoprosthesis: Visual Outcomes, Device Retention, and Complications

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To the Editor:
Dear Editor, we are grateful to the authors of “Boston type 1 keratoprosthesis: visual outcomes, device retention, and complications” for quantitating the most common and significant complications associated with KPro-1 use.1 The article details the use of a variety of prophylactic measures and suggests avenues for additional research that could further improve KPro-1 outcomes.
Retinal detachment, one of the most common and devastating complications reported, occurred in 12% of the study patients and was invariably associated with permanent loss of functional vision. The mean duration of patient follow-up in this study was 41.1 months, but other studies suggest that the risk of retinal detachment may increase with time, reaching 21.5% at 5 years and 44.8% at 10 years.2
We believe that it may be possible to reduce the frequency of retinal detachment by carefully inspecting and completely treating the peripheral retina with laser cerclage before KPro-1 placement. Such inspection and cerclage is most effectively done through a wide-field temporary keratoprosthesis (TKP) placed at the same sitting and just before KPro-1 placement. TKP-enabled vitrectomy may also enhance aqueous shunt function by permitting more complete removal of the peripheral vitreous.3–5
We propose that a prospective, multicenter, randomized, clinical trial be used to study the efficacy of peripheral retinal inspection and cerclage through TKP vitrectomy in the prevention of retinal detachment, immediately before KPro-1 placement. Those centers wishing to participate in such a study should contact the KPro Study Group for further information.
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