Boston Keratoprosthesis in Stevens-Johnson syndrome: a case of using infliximab to prevent tissue necrosis

PURPOSE: To report the case of a patient with Stevens-Johnson Syndrome (SJS) with Boston Keratoprosthesis (KPro) who may have benefited from infliximab infusions. MATERIALS AND METHODS: A 34-year-old woman with a history of acute SJS at age 12 had three Boston KPro Type II implanted since 2003 into her right eye. The first two were followed by tissue necrosis and aqueous leak, necessitating reoperation. After the third device was implanted, monthly infliximab infusions were started. METHODS: Infliximab 5 mg/kg infusions were started in January 2008, repeated after 2 weeks, and then given monthly for a year. The treatment is continuing combined with regular eye examinations. RESULTS: While receiving infliximab, the skin around the keratoprosthesis has not shown a trace of retraction or necrosis. This is in sharp contrast to events following the two previous attempts at visual rehabilitation. The patient's vision has been generally stable for a year and is currently 20/30. CONCLUSION: A KPro in a patient with SJS normally has a poor long-term prognosis. However, retention of the prosthesis and visual outcome may benefit from monthly infliximab infusions.