Infliximab after Boston Keratoprosthesis in Stevens–Johnson Syndrome: An Update

ABSTRACT

Purpose: To report our experience using intravenous infliximab for the treatment of tissue melt after Boston keratoprosthesis (B-KPro) types I and II in patients with autoimmune disease.

Methods: Case series.

Results: We identified four patients who were treated with intravenous infliximab in the context of tissue melt after B-KPro. Stevens–Johnson syndrome-associated corneal blindness was the primary surgical indication for B-KPro implantation in all patients. Two patients received a B-KPro type I and two patients received a B-KPro type II. The patients received intravenous infliximab for skin retraction around B-KPro type II, melting of the carrier graft or leak. Treatment resulted in a dramatic decrease in inflammation and, in some cases, arrest of the melting process. Cost and patient adherence were limiting factors to pursuing infliximab therapy. In addition, one patient developed infusion reactions.

Conclusions: Intravenous infliximab may be considered as globe- and sight-saving therapy for tissue melt after B-KPro.

Keywords:

• Boston keratoprosthesis
• corneal melting
• infliximab
• keratolysis
• Stevens–Johnson syndrome

DECLARATION OF INTEREST

The authors alone are responsible for the content and writing of the paper.

MCR, AC, LQS, GNP, RD, JC and CHD are employees of the Massachusetts Eye and Ear Infirmary, the manufacturer of the Boston keratoprosthesis.