The risk of retinal detachment following Boston Keratoprosthesis Type 1 Implantation: Insights from a Retrospective case review

To evaluate the incidence, risk factors, management strategies, and visual outcomes of retinal detachment (RD) following Boston Keratoprosthesis Type 1 (KPro) implantation. Single-center, retrospective observational case series. Medical records of 157 eyes from 122 adult patients who underwent Boston Type 1 KPro implantation at a tertiary care center between 2008 and 2022 were reviewed. Inclusion criteria included age ≥18 years and postoperative follow-up of at least 1 year. Demographic data, preoperative characteristics, postoperative complications, and visual outcomes were collected. Univariate and multivariate statistical analyses were conducted to identify significant risk factors for RD. Cox regression and Kaplan-Meier survival analysis were used to evaluate time-to-event data. Of the 157 eyes that underwent Boston Type 1 KPro implantation, 27 eyes (17.2%) developed retinal detachment (RD), all within 8 years postoperatively (2 RD per 100 eye years). Aniridia was significantly associated with increased RD risk (OR: 2.79; 95% CI: 1.23-6.70), while other preoperative diagnoses were not. Eyes with RD were more likely to experience hypotony (OR: 7.63; p<0.0001), choroidal detachment (OR: 7.67; p<0.0001), phthisis (OR: 7.69; p<0.0001), and other serious complications. Surgical intervention was possible in 16 of the 27 RD cases, with pneumatic retinopexy being the most common approach. Retinal detachment is a significant complication following KPro implantation, particularly in patients with aniridia. Postoperative hypotony and other inflammatory complications may contribute to increased RD risk and challenge surgical repair. Close monitoring of high-risk patients may help mitigate long-term visual morbidity.