Epithelialization of the anterior surface of the optic as a newly discovered problem of type I Boston Keratoprosthesis

Background and objectives: The corneal disorders represented one of first 5 causes responsible of blindness all over the world. Failed keratoplasty commonly occurs in patients with poor prognosis. The Boston Keratoprosthesis (BKPro type-I) is the first option for managing these patients; however, many postoperative complications have been reported. Our aim was to determine the incidence of epithelialization of the anterior surface of the optic of type I Boston Keratoprosthesis in patients who underwent Prosthokeratoplasty. Methods: A retrospective study was implemented in North Eye Center in Hawler city, Kurdistan region, Iraq. Data from sixty patients who underwent BKPro type-I from August 1, 2017, to March 31, 2023, were reviewed. Epithelialization of optical anterior surface was implemented through researcher in regard to finding epithelial layer affecting vision on slit lamp examination, with the visual acuity measurement pre and postoperatively. Results: Postoperative complications were observed in 66.7% of patients following BKPro type-I, Epithelialization was present in 10% of all patients. The VA was moderate visual impairment in 83.3% of patients with epithelialization, whilesevere visual impairment in 16.7% of patients with epithelialization. There was a highly significant improvement in VA post Prosthokeratoplasty (p<0.001). No significant differences were observed between patients with postoperative epithelialization and patients without postoperative epithelialization regarding follow up periods (p=0.2). There was a significant association between late onset complications and postoperative epithelialization (p=0.03). Conclusions: Boston type 1 keratoprosthesis is effective with restoring vision among patients with poor prognosis corneal blindness although elevated rate of postoperative complications.