Contact Lens Fitting and Long-Term Management for the Boston Keratoprosthesis

Abstract

Our results show that it is often necessary to use custom contact lenses for K-Pro patients. Management of poor tear film quality, protein deposition, inflammation, lens replacement schedule, and antibiotic resistance are related considerations.

Contact Lens Use in Patients With Boston Keratoprosthesis Type 1

“…One review stated that on average 2.2 lenses were required to achieve a successful fit in KPro patients. 11 Without lens loss or apparent poor fit, patients may remain in the initial postsurgical Kontur lens parameters.…”

“…A well-fit contact lens should be centered without air bubbles and adequate movement with the patient's blink. 11 If the lens buckles centrally, the lens diameter may be too large or the base curve may be too steep. The patient's fornices may push on the lens causing lens loss.…”

“…If a patient has a very flat ocular surface and the flattest 9.8 mm base curve Kontur lens is not fitting appropriately, the Flexlens ARC (Definitive Silicone Hydrogel 74%) (X-Cel Contacts Inc., Bellevue, WA) may be the lens of choice as it is available with a base curve as flat as 11.0 mm. 11 Another option for very steep ocular surfaces is to change the lens design to a FLEXLENS Tri-curve Keratoconus Lens (X-Cel Contacts Inc., Bellevue, WA). 12 In our practice, we educate patients that they will require the lifelong use of a bandage contact lens and medications.…”

“…Included among these complications are infection, glaucoma, retroprosthetic membranes, corneal melt, dellen formation, macular edema, and retinal detachment. 11 The majority of KPro complications related to the ocular surface are secondary to evaporative drying of the tissue and surface inflammation. 11 Localized drying can occur around the front plate of the device and interfere with epithelial healing.…”

“…11 The majority of KPro complications related to the ocular surface are secondary to evaporative drying of the tissue and surface inflammation. 11 Localized drying can occur around the front plate of the device and interfere with epithelial healing. 12 In addition, KPro patients often have a compromised ocular surface due to limbal stem cell deficiency, keratoconjunctivitis sicca, neurotrophic keratitis, and exposure keratopathy.…”