Boston KPro Type I in the Pediatric Age Group

Corneal opacity in pediatric patients may be congenital or acquired. Significant corneal opacities in infants can lead to profound deprivation amblyopia. For this reason, early surgical intervention to provide a clear visual axis is recommended. Surgery usually involves a full thickness penetrating keratoplasty (PK). Although PK results are excellent in most adult patients, pediatric cases are not as successful due to the technical difficulty of this surgery, higher rates of graft failure from allograft rejection, and challenges in postoperative visual rehabilitation. The Boston type 1 keratoprosthesis (KPro), once considered a last resort in patients with multiple PK failures, is now considered a reasonable alternative. It even can be the first-line option for cases known to be at high risk for failure with traditional donor corneal transplantation. Thus far, studies of adult patients have shown favorable outcomes with the KPro, with rapid visual recovery and excellent retention rates. KPro may also be useful in the treatment of pediatric corneal opacity as it can restore a clear visual axis quickly and thus may be useful in amblyopia prevention. It does not opacify and cannot be rejected. In addition, the built in refractive rehabilitation even in aphakic patients is advantageous, particularly in pediatric cases. Initial reports from a few centers demonstrate encouraging results from pediatric KPro surgeries.