1. UC Davis Long-Term Outcomes of the Boston Type I Keratoprosthesis Jennifer Li, M.D., Mark Greiner, M.D. Ana Carolina Vieira, M.D. Mark Mannis, M.D. University of California, Davis Sacramento, California The authors have no financial interest in the subject matter of this poster.

2. UC Davis Study Purpose To evaluate long-term outcomes after placement of Boston type 1 keratoprosthesis To determine the types and frequency of complications that may develop postoperatively

3. UC Davis Materials and Methods A retrospective chart review of all Boston type 1 keratoprosthesis surgeries performed at a single institution (UC Davis) beginning in May, 2004 through January, 2010

4. UC Davis Boston Keratoprosthesis UC Davis, 2004-2010 Demographics Number of eyes40 Number of patients35 Average age 52.9 years (range 2-86 years) Gender 57% M 43% F Average follow-up time30.1 months

5. UC Davis Patient Demographics Preoperative Corneal Diagnosis# Eyes (%)Avg. # Prior PKPs Chemical burn10 (25.0%)1.6 Failed graft NOS7 (17.5%)2.3 Aniridia5 (12.5%)1.6 Keratoconus4 (10.0%)3.0 HSV4 (10.0%)2.5 Congenital hereditary endothelial dystrophy 2 (5.0%)1.0 Other Thermal burn, Apert’s syndrome, ocular cicatricial pemphigoid, Peters, Stevens-Johnson, rheumatoid arthritis, Fuchs endothelial dystrophy, HLA-B27 uveitis 8 (20.0%)2.3 Total40 (100%)2.0

6. UC Davis Preoperative BCVA

7. UC Davis Preoperative Glaucoma Number of eyes with glaucoma (%) 23 (57.5%) Average number of preop glaucoma medications 1.52 Number of eyes with prior glaucoma surgery (%) 14 (35%)

8. UC Davis Preoperative versus Postoperative BCVA

9. UC Davis Postoperative BCVA Changes: Comparing pre-op to final post-op BCVA

10. UC Davis Postoperative Complications Complications of K-Pro# Eyes (%) Retroprosthetic membrane22 (55.0%) YAG laser membranectomy10 (25.0%) Surgical membranectomy5 (12.5%) Endophthalmitis5 (12.5%) Glaucoma31 (77.5%) * Progression11 (27.5%) GDD placement (excluding concomitant GDDs) 1 (2.5%) GDD erosion8 (20.0%) ** Transscleral cyclophotocoagulation2 (5.0%) Endocyclophotocoagulation3 (7.5%) End-stage glaucoma7 (17.5%) Corneal melt with K-Pro extrusion6 (15.0%) Replacement of K-Pro7 (17.5%) Removal of K-Pro3 (7.5%) **7 of 8 GDD erosions required revision and/or removal of device. *23 (57.5%) had preoperative glaucoma diagnosis.

11. UC Davis Retroprosthetic Membrane Exposed Tube Shunt Periprosthetic Infiltrate Extrusion of Keratoprosthesis

12. UC Davis Conclusions High percentage of patients have long-term BCVA equal to or better than pre-operative visual acuity There is a moderately high percentage of patients with long-term complications status post Boston type 1 keratoprosthesis placement Progression of glaucoma and complications related to glaucoma can be visually devastating Although many patients may benefit from keratoprosthesis placement, long-term visual prognosis is guarded. Successful management of these patients requires pre- and post-operative collaboration with glaucoma and vitreoretinal specialists Further study is needed to determine the best means of managing postoperative glaucoma