The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.

Purpose-To report the outcomes of medical and surgical management for congenital aniridiaassociated keratopathy (AAK) over a long follow-up period. Design-Retrospective, comparative case seriesMethods-Medical records of patients diagnosed with congenital aniridia were retrospectively reviewed. Age, gender, ethnicity, follow-up time, AAK stage, non-corneal abnormalities, ocular surgeries, and complications were recorded. The visual acuity equivalent (VAE), approximate Early Treatment Diabetic Retinopathy Study (appETDRS) letter score, was calculated using recorded Snellen visual acuities.Results-Ninety-two eyes of 47 patients (31 females) with mean age of 48.0±18.0 years, and mean follow-up of 78.6±42.2 months were included. At the initial visit, 12 eyes (13%) were classified as stage I AAK, 33 eyes (35.9%) stage II, 25 eyes (27.2%) stage III, 17 eyes (18.5%) stage IV and 5 eyes (5.4%) stage V. Limbal stem cell transplantation (LSCT) and Boston Keratoprosthesis (KPro) were frequently performed on eyes with stages III-V. These advanced corneal surgeries significantly improved the median (95% CI) of calculated appETDRS scores from 2(0-20) to 26(15-41) (Snellen, 20/20000 to 20/300, P=0.0004). Patients with earlier stages (I-II) of AAK were managed medically and had stable visual acuity through their final visits *

To report the clinical presentation and the role of intrastromal and intracameral voriconazole injection in the management of rare cases of fungal keratitis caused by Lasiodiplodia theobromae.Two eyes of 2 patients with Lasiodiplodia keratitis unresponsive to topical and oral antifungal medications were included in this study. Diagnosis of Lasiodiplodia keratitis was confirmed by microbiological analysis, including culture-based (case 1 and 2) and DNA sequencing techniques (case 2 only).The first patient presented with multiple satellite lesions and one of these infiltrates spread deeply into the cornea, forming a stromal abscess. Another patient had a large full-thickness corneal infiltrates with several fungal balls in the anterior chamber, requiring a limbus-to-limbus therapeutic penetrating keratoplasty. Despite aggressive topical therapy, the stromal abscess continued to worsen in the first case and recurrent keratitis was observed postoperatively in the second case. Voriconazole 50 μg/0.1 mL was administered intracamerally and intrastromally around the fungal abscess as adjuncts to topical antimycotics in the first case. The second patient who needed therapeutic keratoplasty was treated with an intracameral injection of 50 μg/0.1 mL voriconazole at the end of surgery. Postoperatively, 100 μg/0.1 mL voriconazole was also injected intracamerally after the recurrence of infection was noted in the graft. Reinjections were given 48 hours apart in both cases. After the injections, all corneal and anterior chamber lesions were reduced in size and density and completely resolved within 4 weeks.Intrastromal and intracameral voriconazole injections may offer safe and effective treatment options for L theobromae keratitis.

Purpose To investigate the medium-term clinical outcomes and risk factors for primary graft failure after Descemet membrane endothelial keratoplasty (DMEK) in Thai patients. Patients and Methods This is a single-center retrospective cohort study. Sixty-two eyes of 62 patients who underwent DMEK at Ramathibodi Hospital, Bangkok, Thailand, with a minimum of 24-month follow-up were recruited. Preoperative donor and recipient characteristics, intraoperative data, and postoperative outcomes including best-corrected visual acuity (BCVA), graft clarity, endothelial cell density (ECD), central corneal thickness (CCT), and complications were evaluated at 1, 3, 6, 12, and 24 months after surgery. Results The mean age of the patients was 67.2 ± 9.9 years, and 52% were female. The mean follow-up time was 37.5 ± 11.0 months. The most common indications for DMEK were Fuchs’ endothelial corneal dystrophy (FECD) (53.2%) and pseudophakic bullous keratopathy (PBK) (17.7%). Nearly half of patients had triple-DMEK. The median preoperative BCVA was 20/400. Postoperative BCVA of ≥ 20/40 was reached in 37.1% and of ≥ 20/20 in 6.5% after 1 month which increased to 54.8% and 17.7% after 3 months; and to 67.7% and 27.4% after 24 months. Endothelial cell loss (ECL) at 3, 6, 12, and 24 months was 30.5%, 33.8%, 44.4%, and 45.9%, respectively. Graft diameter was the single factor, showing a significant relationship with postoperative ECD. Most frequent postoperative complications included graft detachment (22.6%), increased IOP/glaucoma (17.7%), and primary graft failure (16.1%). In univariate analysis, death-to-operation time and the diagnosis of PBK were significantly associated with the occurrence of primary graft failure. Conclusion DMEK is a safe, effective, and feasible treatment for endothelial failure in Asian eyes. Careful case selection, use of relatively fresh donor tissues, and appropriate surgical techniques can prevent primary graft failure and facilitate optimal outcomes following surgery.