Keratoprosthesis in Autoimmune Disease

Abstract

Purpose: To describe the clinical features and course of 2 patients with autoimmune diseases and their experience with the Boston keratoprosthesis. To draw on general medical literature to try to better understand recurrent complications.

Methods: Retrospective review of 2 patients treated with Boston keratoprostheses. The clinical histories, examinations, and other diagnostics were reviewed. A literature review was performed.

Results: The first patient presented with end-stage ocular disease secondary to toxic epidermal necrolysis (TENS). The second patient presented with end-stage ocular disease secondary to mucous membrane pemphigoid (MMP). Both patients underwent treatment with the Boston keratoprosthesis. Both patients suffered numerous corneal melts requiring multiple repeat implantations.

Conclusions: Patients with corneal blindness secondary to autoimmune disease often fare poorly with available surgical treatments. Study of existing literature on prosthetic device complications in autoimmune diseases may help uncover common mechanisms of tissue destruction to establish perioperative immunomodulatory regimens targeted to specific underlying diseases.

KEYWORDS::

• autoimmune disease
• keratoprosthesis
• mucous membrane pemphigoid
• Stevens-Johnson syndrome

ACKNOWLEDGMENTS

Supported in part by an unrestricted grant to the Department of Ophthalmology, Harvard Medical School, from Research to Prevent Blindness, NY, NY.

Declaration of interest: This work was supported by an unrestricted grant to the Department of Ophthalmology – Harvard Medical School, from Research to Prevent Blindness, NY, NY. Drs. Chodosh, Papaliodis, and Dohlman work for the Massachusetts Eye and Ear Infirmary, which distributes the Boston keratoprosthesis. Any profits from sales of the Boston keratoprosthesis are used for research.

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