Boston Type 1 Keratoprosthesis With Autologous Buccal Mucosa Overlay for Cases With Severe Ocular Surface Alterations.

Abstract

To evaluate anatomical and functional outcomes, and complications, of Boston type 1 keratoprosthesis with autologous oral mucosa graft (B1KProM) to reconstruct and protect the ocular surface of eyes with severe conditions. Retrospective interventional case series. Data from 19 eyes of 19 patients (12 males; mean age of 61 ± 18 years) with irreversible corneal opacification (autoimmune diseases [11], chemical burns [5], or other [3]), who underwent B1KProM surgery. Anatomical success was defined as retention of the keratoprosthesis during the follow-up and functional success as postoperative best-corrected visual acuity (BCVA) ≤1.3 logMAR at the last follow-up. The median mucosal reepithelialization time was 3 weeks. Mucosal complications were poor epithelization, overgrowth, and necrosis and occurred in 14 episodes in 9 eyes (47%), all successfully managed, except in 2 eyes with concomitant extrusion. The incidence of other complications was under previously described ranges. Anatomical failure occurred in 4 of 19 cases (21%), all of them with autoimmune diseases. Cumulative probability of anatomical success was 89%, 80%, and 40% at 12, 24, and 36 months, respectively. BCVA ≥20/200 was found at some point postoperatively in 11 of 12 cases (92%) with visual potential. Cumulative probability of functional success was 89%, 78%, and 29% at 12, 24, and 36 months, respectively. The mean follow-up was of 18±12 months (range: 1-36 months). B1KProM emerges as a promising option for patients with complex ocular surface conditions. Mucosal complications were frequent but manageable. Further research is essential to confirm its long-term effectiveness.