Vision-related quality of life improvement after implantation of Boston keratoprosthesis

Session Details

Session Title: Cornea Surgical II

Session Date/Time: Tuesday 16/09/2014 | 08:00-10:30

Paper Time: 09:02

Venue: Boulevard B

First Author: : M.Cortina USA

Co Author(s): :    J. de la Cruz              

Abstract Details

Purpose:

To determine the impact of Boston keratoprosthesis implantation on patient-reported visual function

Setting:

University of Illinois Eye & Ear Infirmary, Department of Ophthalmology and Visual Sciences. Cornea and External Disease Service

Methods:

Patients 18 years old or older undergoing implantation of Boston keratoprosthesis (KPro) for visual rehabilitation in our institution were enrolled in the study. National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) was used to assess vision-related quality of life preoperatively and postoperatively at 3 months, 6 months and yearly thereafter. Baseline scores were compared to postoperative scores at 3 months and to the average score of all postoperative questionnaires obtained until last follow up visit using paired TTEST

Results:

Twenty-five patients were included in the study. Preoperative diagnosis included: aniridia (n=6), failed graft (n=6), chemical burn (n-3), Steven Johnson’s syndrome (1), HSV keratitis (n=2), chronic uveitis/hypotony (n=4) and other causes of limbal stem cell deficiency (n=3). 24 patients were implanted with the type 1 and 1 patient with the type 2 model of Boston KPro. Mean baseline NEI VFQ-25 overall score was 43.7. At 3 months; the mean overall score was 70.1 representing a statistically significant change (p=0.001). Breakdown of subcategories within VFQ-25 showed significant improvement in general vision, near and distance activities, social functioning, mental health, role difficulties, dependency, color vision and peripheral vision (p<0.05). Overall health, ocular pain and driving subcategories showed a trend towards improvement but were not statistically significant. Mean follow up for all patients was 12.5 months. Patients with visual acuity of 20/200 or better in the contralateral eye were compared to patients with vision worse than 20/200. Although a greater change in scores was observed in the latter group; the first group showed a statistically significant improvement in overall scores and subscale scores compared to baseline with the greatest change observed in overall general vision (mean change= 30.3), and peripheral vision (mean change=36.1).

Conclusions:

These data provide vision-related, patient-reported outcome evidence that supports benefits of Boston KPro implantation for visual rehabilitation in patients with poor prognosis for other types of corneal transplantation. It also supports the use of type 1 model in patients with relatively good visual acuity in the contralateral eye. Results are maintained over 1 year in our study but longer studies are needed to prove sustainability of this benefit over time.

Financial Interest:

NONE