Keratoprosthesis: procedure of choice for corneal opacities in children?

PURPOSE

The purpose of this study is to review the current literature on keratoprosthesis and its use in the pediatric population.

METHODS

Case report and review of recent literature on outcomes of pediatric keratoplasty and keratoprosthesis.

RESULTS

Penetrating keratoplasty in children is fraught with shortcomings, including difficulty maintaining a clear graft (as low as 44% at 50 months), poor visual acuity outcomes (only 30-34% achieving 20/400 or better), and a high rate of allograft rejection (40-50%). Placement of the Boston type I keratoprosthesis has the advantage of achieving a clear visual axis and stable refractive error within days of surgery without risk of rejection. However, life-long care is required, including topical steroids and antibiotic prophylaxis, as well as bandage contact lens wear and a frequent a need for further interventions for retroprosthetic membranes and glaucoma.

CONCLUSIONS

With motivated parents, a successful anatomic and functional outcome can be achieved with the Boston keratoprosthesis in children of amblyogenic age.