Ocular surface, fornix, and eyelid rehabilitation in Boston type I keratoprosthesis patients with mucous membrane disease.

Purpose: To understand the efficacy of various approaches for ocular surface reconstruction in eyes with implanted Boston Type I keratoprosthesis.

Methods: All eyes implanted with a Boston Type I keratoprosthesis over a 9-year period by a single surgeon were reviewed. Any case in which mucosal rehabilitation was performed was included in the study sample. The type, number, approach, and outcome for all eyelid and ocular surface procedures were assessed.

Results: A total of 22 mucosal surface surgeries were performed before, concurrent with, and after implantation of 11 keratoprostheses and 1 penetrating keratoplasty (after keratoprosthesis removal) in 9 eyes of 9 patients. Most of the ocular surface reconstructive surgeries (81.8%; 18/22) were performed at the time of or following keratoprosthesis implantation, with the most common indication being corneal stromal necrosis (44.4%; 8/18). Free grafting and simple advancement resulted in graft retraction for each case, and pedicle or bucket handle flaps resulted in a stable vascularized graft for half of the cases. Graft retraction occurred in 6 of the 9 eyes in this study, including in all 5 eyes of patients with Stevens Johnsons syndrome (SJS).

Conclusions: Free grafting and simple advancement flaps do not appear to be effective for rehabilitation in these eyes. However, even vascularized pedicle and bucket handle flaps retracted 50% of the time. Individuals with SJS were more likely to both require conjunctival rehabilitation after keratoprosthesis surgery and develop graft retraction in the course of management.