CASE REPORT: “Boston type I keratoprosthesis with buccal mucosal overlay in severe chemical burn” ‘Barcelona CP’

Abstract

Objective To describe a case of severe chemical burn treated with a novel Boston type I keratoprosthesis (B1-KPro) technique. Methods We present the case of a 25-year-old woman with poor light perception in both eyes who had bilateral chemical burn with caustic soda 3 months earlier. She underwent several amniotic membrane implants and subconjunctival triamcinolone injections without significant improvement. We decided to perform a two-stage surgery on the right eye (RE). Reconstruction of the ocular surface was first performed using a buccal mucosa allograft. Nine months later the second surgical stage was performed, which consisted of partial lifting of the buccal mucosa, B1-KPro implantation covered with the buccal mucosa overlay and exposing the optics of the keratoprosthesis. Results Two days following surgery the uncorrected visual acuity (UCVA) was +0.2 logMAR. Best-corrected visual acuity (BCVA) at one month was 0,0 logMAR, remaining stable after one year and eleven months of follow-up. Conclusions Boston type 1 keratoprosthesis covered with buccal mucosa (B1-KPro with mucosa overlay technique) could be considered an alternative in severe ocular chemical burn with marked shortening of the fornix, as an alternative to osteo-odonto-keratoprosthesis (OOKP) or tibial bone keratoprosthesis or when the Boston type II keratoprosthesis is not available. It allows restoration of the anatomy and condition of the ocular surface using autologous tissue, with better aesthetics than OOKP and material easily available as it has the CE marking.