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    Managing repeat transplant failure

    Keratoprosthesis implantation compares favorably with keratoplasty for corneal graft failure

     

    Keratoprosthesis (KPro) implantation appears to result in similar or better outcomes than penetrating keratoplasty (PK) in patients who have had corneal graft failure, according to Anthony J. Aldave, MD.

    Patients receiving the Boston type 1 keratoprosthesis (Massachusetts Eye and Ear Infirmary) enjoy a greater likelihood of improved visual acuity without a higher risk of postoperative glaucoma, Dr. Aldave and colleagues found.

    “The percentage of patients with a visual acuity of 20/200 or better 2 years following Kpro implantation is higher than in patients who have had repeat PK, although given the nature of the study we didn’t perform statistical analyses to determine if the difference between the groups was significant,” said Dr. Aldave, professor of ophthalmology at the University of California, Los Angeles.

    Weighing options

    Patients with failed corneal grafts have two surgical options: another keratoplasty or a keratoprothesis, he noted.

    “There has been a lot of discussion regarding the optimal management of patients with repeat transplant failure,” Dr. Aldave said.

    To compare these approaches, Esen Akpek, MD, professor of ophthalmology, Wilmer Eye Institute, Johns Hopkins University of Medicine, Baltimore, and colleagues including Dr. Aldave and others focused on the most common form of keratoplasty performed for corneal graft failure, PK, and the most commonly implanted keratoprosthesis, the Boston Type I.

    This device consists of a PMMA front plate and optic, a PMMA or titanium back plate and a donut of donor corneal tissue sandwiched between them.

    In reviewing the literature, Dr. Aldave and his colleagues could not find any controlled trials comparing outcomes of keratoprostheses with donor corneas in patients undergoing repeat transplantations.

    They identified 45 reports of 26 non-randomized studies evaluating outcomes for patients undergoing repeat PKs after a history of failed corneal transplantation. The meta-analysis that they performed focused on the outcomes in 3,344 patients in 10 of these 26 studies.

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