Infection and inflammation in Boston Type 1 KPro

Purpose We show possible risk factors for extrusion or endophthalmitis , significance of different clinical features, how to approach them clinically and surgically in order to try to obtain the most successful results in patients who underwent Boston KPro type I surgery. Methods Review of clinical experience through the last 6½ years dealing with Boston KPro type I surgeries and subsequent possible complications such as melting, thinning, extrusion and endophthalmitis. Results The main risk factor for KPro failure is inflammation level of the ocular surface. The origin of this inflammation can be diverse: blepharitis, mechanical, immunological. Many inflammatory molecules, through different pathways, can lead to an increase of many metalloproteinases which are involved in the digestion of corneal collagen, producing melting, cornea thinning or even KPro extrusion. Infectious keratitis or endophthalmitis are other dramatic possible complications in KPro patients that can also be associated to collagenolisi Conclusion Control of ocular surface inflammation is crucial to succeed in the postop of KPro surgeries. In order to achieve this point, management of clinical signs, use of different topical and systemic drugs, and some tricky surgeries should be learned. In case of endophthalmitis, very early surgery consisting of removal of KPro, pars plana vitrectomy and keratoplasty is mandatory.