Thermal analysis of dry eye subjects and the thermal impulse perturbation model of ocular surface.

In this study, we explore the usage of ocular surface temperature (OST) decay patterns to distinguished between dry eye patients with aqueous deficient dry eye (ADDE) and meibomian gland dysfunction (MGD). The OST profiles of 20 dry eye subjects were measured by a long-wave infrared thermal camera in a standardized environment (24 °C, and relative humidity (RH) 40%). The subjects were instructed to blink every 5 s after 20 âˆ¼ 25 min acclimation. Exponential decay curves were fit to the average temperature within a region of the central cornea. We find the MGD subjects have both a higher initial temperature (p < 0.022) and a higher asymptotic temperature (p < 0.007) than the ADDE subjects. We hypothesize the temperature difference among the subpopulations is due to tear volume and heat transfer mechanisms. To study the validity of our claim, we develop a mathematical model, referred to as the thermal impulse perturbation (TIP) model. We conclude that long-wave-infrared thermal imaging is a plausible tool in assisting with the classification of dry eye patient.

Long-term outcomes of boston type 1 keratoprosthesis implantation: a retrospective multicenter cohort.

PURPOSE: To study the long-term outcomes of Boston type 1 keratoprosthesis (KPro) surgery. DESIGN: Retrospective, multicenter case series. PARTICIPANTS: A total of 158 eyes of 150 patients underwent KPro implantation at 5 participating tertiary centers in the United States between January 2003 and December 2006. Of those, 139 eyes of 133 patients were included in the analyses. METHODS: The medical records of consecutive adult patients who received KPro surgery were reviewed. All patients with at least 1 postoperative visit were retained in the outcomes analyses. In eyes in which a repeat KPro procedure was performed, only the outcomes of the initial surgery were analyzed. MAIN OUTCOME MEASURES: Visual acuity (VA) outcomes, postoperative complications, and device retention. RESULTS: The mean follow-up was 46.7 ± 26 months with all but 4 eyes having at least 6 months of follow-up. Preoperatively, only 10.8% of the eyes had VA of ≥ 20/200. Postoperatively, the VA in 70% of eyes improved to ≥ 20/200. The probability of maintaining VA of ≥ 20/200 at 7 years was 50%. The device retention rate was estimated at 67% at 7 years. The 7-year cumulative incidence of complications was 49.7% for retroprosthetic membrane formation, 21.6% for glaucoma surgery, 18.6% for retinal detachment, and 15.5% for endophthalmitis. CONCLUSIONS: Although the risk for complications with longer follow-up seemed to increase, this large multicenter cohort demonstrates favorable outcomes with KPro, with a large number of patients achieving and retaining useful vision over a 7-year period.

Phantom study of tear film dynamics with optical coherence tomography and maximum-likelihood estimation.

In this Letter, we implement a maximum-likelihood estimator to interpret optical coherence tomography (OCT) data for the first time, based on Fourier-domain OCT and a two-interface tear film model. We use the root mean square error as a figure of merit to quantify the system performance of estimating the tear film thickness. With the methodology of task-based assessment, we study the trade-off between system imaging speed (temporal resolution of the dynamics) and the precision of the estimation. Finally, the estimator is validated with a digital tear-film dynamics phantom.

Infectious endophthalmitis in adult eyes receiving Boston type I keratoprosthesis.

PURPOSE: To report the clinical characteristics of infectious endophthalmitis after Boston type I keratoprosthesis (K-Pro) implantation. DESIGN: Retrospective study. PARTICIPANTS: One hundred forty-one adult eyes receiving a K-Pro at a single institution from May 2004 through July 2008. METHODS: A retrospective chart review was performed of all adult eyes receiving a K-Pro at the University of Rochester from May 2004 through July 2008. Those patients identified as having been treated for exogenous bacterial endophthalmitis were reviewed for demographic data, indication for K-Pro, bandage contact lens use, prophylactic antibiotic use, timing and clinical presentation of endophthalmitis, gram stain and culture results of intraocular fluid, timing and presentation of any subsequent episodes of endophthalmitis (recurrent endophthalmitis), and preoperative and postoperative visual acuity through August 2010. MAIN OUTCOME MEASURES: Incidence of endophthalmitis, time to occurrence, recurrence rates, visual outcomes, and risk factors associated with K-Pro endophthalmitis. RESULTS: Ten (7.1%) of 141 eyes of 130 adult patients were diagnosed and treated for bacterial endophthalmitis. Average time to endophthalmitis developing after K-Pro was 9.8 months (standard deviation [SD], 6.2 months; range, 2-25 months). Coagulase-negative staphylococci were identified in 7 eyes. In 7 of the 10 eyes, recurrent endophthalmitis developed that occurred at a mean of 4 months (SD, 3.9 months; range, 1-13 months) after resolution of the initial episode. At each episode of endophthalmitis, no eye was receiving vancomycin ophthalmic drops and most eyes were receiving only fluoroquinolone ophthalmic drops for prophylaxis. CONCLUSIONS: Infectious endophthalmitis after K-Pro implantation has a higher incidence, delayed onset, and high risk for recurrence compared with postoperative endophthalmitis associated with more common intraocular procedures such as cataract surgery. The concurrent use of topical vancomycin is recommended because it seems to be important in reducing the incidence and recurrence of endophthalmitis and because fluoroquinolone ophthalmic drops do not seem to be sufficient prophylaxis in these eyes.

Integrated multimodal metrology for objective and noninvasive tear evaluation.

The clinical tests used to assess tear film and diagnose dry eye are invasive and produce results that are different from natural tear characteristics. There is a need to objectively and noninvasively assess tear parameters under controlled environmental circumstances to refine dry eye diagnosis and therapy. We have developed multimodal tear imaging systems integrated in a chamber in which individual environmental factors can be precisely varied to investigate their impacts on tear parameters. With the custom-built high-resolution wavefront sensor combined with placido disc, it is possible to objectively detect two-dimensional tear breakups in real time and evaluate its impact on visual quality. Micrometer ultra-high resolution optical coherence tomography (OCT) enables us to quantify thickness and volume of the tear over the cornea and tear menisci. The ocular surface imaging ellipsometer uses polarized illumination from which both the lipid refractive index and thickness can be measured at a very high resolution. Using an enhanced thermal camera, we measure the ocular surface temperature noninvasively, which makes it possible to study spatial and temporal changes in tear evaporation. The multimodal deployment of these four components in the controlled chamber will assist in better differentiating the various clinical dry eye entities and will lead to the development of specific dry eye treatments.

Titanium back plate for a PMMA keratoprosthesis: clinical outcomes.

BACKGROUND/PURPOSE: To compare the rate of retroprosthetic membrane (RPM) formation in Boston Keratoprosthesis (BKPro) with polymethyl methacrylate (PMMA) versus titanium backplates. DESIGN: Retrospective comparative chart review. METHODS: Multicenter study population: a total of 78 eyes with keratoprosthesis implants with either PMMA or titanium backplates were included in the study. To be included in the study, all subjects had to have completed a minimum of 6-month follow-up period. Incidence of RPM development at 6-month postoperative period was noted across the study population. PMMA and titanium backplates were then compared by their rate of association with subsequent RPM. RESULTS: Twenty-three out of 55 eyes (41.8%) with PMMA backplates and three out of 23 eyes (13.0%) with titanium backplates had developed an RPM at 6 months after implantation. The titanium backplates were associated with significantly less RPM formation than PMMA backplates (p = 0.014, Chi-square test). CONCLUSIONS: Titanium seems to be associated with less RPM formation than PMMA when used as a material for the BKPro back plate.

Short-Term Outcomes of Pediatric Keratoprosthesis With the Near-Complete Conjunctival Flap.

PURPOSE: The Boston keratoprosthesis (KPro) has been used for certain indications in pediatric patients with congenital corneal opacities. Here, we describe the use of a near-complete conjunctival flap at the time of Boston type 1 KPro surgery in pediatric patients, with the goal of improving pediatric KPro outcomes. METHODS: We performed a retrospective chart review of 21 eyes from 16 patients who received their first KPro before the age of 18 years at a tertiary care center in Rochester, NY. Surgeries were performed between 2011 and 2017 (3 years before and after the incorporation of a conjunctival flap, which began in 2014 as part of the pediatric KPro procedure). Patients who had a minimum 1-year postoperative follow-up, or had corneal melts within 1 year of KPro implantation, were included in our study. The main outcome measure in this study was a comparison of the number of complications that required surgical intervention, including retroprosthetic membrane, corneal melt, retinal detachment, and endophthalmitis, in eyes that received KPro implantation without a conjunctival flap compared with eyes that received KPro implantation with a conjunctival flap. Change in the visual acuity up to 1 year postoperatively was also measured. RESULTS: Ten eyes received KPro with no conjunctival flap, and 11 eyes received KPro with a near-complete conjunctival flap. After 1-year postoperative follow-up, eyes receiving a KPro with a conjunctival flap had fewer KPro-related complications requiring surgical intervention (5 vs. 16, P = 0.0002). Corneal melt was seen in 2 of 11 (18%) eyes in the conjunctival flap group and 5 of 10 (50%) eyes in the nonflap group (P = 0.12). No eyes developed endophthalmitis in the flap group, whereas 1 of 10 (10%) eyes developed endophthalmitis in the nonflap group. Visual acuity at 1-year follow-up improved in 9 of 11 (82%) eyes in the flap group compared with 5 of 10 (50%) eyes in the nonflap group (P = 0.3). CONCLUSIONS: Implementation of a conjunctival flap in pediatric KPro may help decrease the short-term postoperative complications requiring surgical procedures and may lead to improved visual acuity after 1 year. Further investigation, including longer-term follow-up, is needed to better understand how the described technique affects surgical outcomes in children.

Short-term visual outcomes of Boston type 1 keratoprosthesis implantation.

PURPOSE: To report the short-term visual outcomes after keratoprosthesis implantation. DESIGN: Retrospective multi center case series (Wilmer Eye Institute and University of Rochester Eye Institute). PARTICIPANTS: One hundred twenty-two patients (126 eyes) with corneal diseases that were deemed ineligible to receive donor corneal transplants. INTERVENTION: Patients underwent a Boston type I keratoprosthesis procedure for visual rehabilitation. MAIN OUTCOME MEASURES: The medical records of the patients were reviewed to assess intraoperative and postoperative complications, uncorrected and best-corrected visual acuity, as well as the degree of refractive error at various time points. RESULTS: One hundred four patients (82.5%) achieved improved vision within 6 months after surgery. An overwhelming majority of those patients who had improved vision had a manifest refraction of plano. The mean spherical refractive error was -0.57 diopters (D) and mean astigmatism was 0.10 D. Cumulatively, 7.1% patients achieved their best-corrected vision at 1 day, 24.6% at 1 week, and 70.6% at 3 months. The patients who achieved their best-corrected visual acuity after the first 3-month period most often were the ones who required multiple surgeries owing to preexisting or postoperative complications. CONCLUSIONS: Boston keratoprosthesis seems to provide rapid visual recovery with excellent uncorrected acuity in the early postoperative period. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

ISOPT Clinical Hot Topic Panel Discussion on Cornea Anterior Segment Disease.

The cornea and its adnexa pose a unique situation of a tightly defined set of requirements for its function. This includes: transparency, perfect built to obtain appropriate refractive power, protective barrier from microbial invaders. Moreso, the cornea also endures extreme external physical conditions (temperature, high and low humidity, winds and alike). All these functions are maintained while preserving a constant state of homogenous wetting. Toward that end the cornea is equipped with an elaborated network of sensory neural network. While enabling the blinking reflex and maintaining the physiological steady state of wetting, this neural network also makes the cornea prone to the discomfort that with or without associated changes seen on medical examination. ISOPT Clinical 2018 discussion touched upon this hypercomplex situation, addressing the role of inflammation and its resulting discomfort in dry eye conditions. The discussion also engulfed the emerging neuropathic pain syndrome that is recently gaining more attention. Another related topic was the utilization of autologous serum tears and its ability to provide amelioration to desperate patients. Finally, the panel discussed the issue of treating corneal infection, including when and how to utilize steroids in the course of therapy. We assume the reader will find interest in this discussion that directly addresses issues seen day in and day out in our busy clinics.

Correlations among upper and lower tear menisci, noninvasive tear break-up time, and the Schirmer test.

PURPOSE: To determine the relationships among tear meniscus parameters, noninvasive tear break-up time (NITBUT), and the Schirmer test. DESIGN: Experimental study. METHODS: Thirty-six subjects were tested on one randomly selected eye. Real-time corneal optical coherence tomography (OCT) was used to image the upper and lower tear menisci during normal and delayed blinking followed by measurement of NITBUT and the Schirmer test. Digital images of the eye were taken for measuring the lid lengths to estimate tear volume in the menisci. RESULTS: Compared with normal blinking, significant increases of tear menisci occurred during delayed blinking (post hoc, P < .01). NITBUT was weakly but significantly correlated with the height (r = 0.36; P = .03) and area (r = 0.37; P = .03) of the lower tear meniscus during normal blinks. NITBUT was also correlated with the lower tear meniscus volume (r = 0.45; P < .05) and total tear meniscus volume (r = 0.43; P < .05) during normal blinking. The Schirmer test was not significantly related to any parameters of the tear menisci, volumes, or NITBUT; however, it was negatively correlated with the age of the subjects (r = -0.47; P = .004). The age was negatively correlated with the upper tear meniscus (r ranged from 0.36 to 0.37 for the radius, height, and area, P < .05) measured during delayed blinking. CONCLUSIONS: NITBUT appears correlated with the lower tear meniscus during normal blinking, and the Schirmer test appears not correlated with the noninvasively measured tear meniscus.

Chemical Burns of the Eye: The Role of Retinal Injury and New Therapeutic Possibilities.

PURPOSE: To propose a new treatment paradigm for chemical burns to the eye - in the acute and chronic phases. METHODS: Recent laboratory and clinical data on the biology and treatment of chemical burns are analyzed. RESULTS: Corneal blindness from chemical burns can now be successfully treated with a keratoprosthesis, on immediate and intermediate bases. Long term outcomes, however, are hampered by early retinal damage causing glaucoma. New data suggest that rapid diffusion of inflammatory cytokines posteriorly (TNF-α, etc) can severely damage the ganglion cells. Prompt anti-TNF-α treatment is markedly neuroprotective. Long term profound reduction of the intraocular pressure is also vital. CONCLUSION: A new regimen, in addition to standard treatment, for severe chemical burns is proposed. This involves tumor necrosis factor alpha (TNF-α) inhibition promptly after the accident (primarily for retinal neuroprotection), prophylactic maximal lowering of the intraocular pressure (starting immediately), and keratoprosthesis implantation in a later quiet state.

Effect of blinking on tear dynamics.

PURPOSE: Optical coherence tomography (OCT) was used to study the impact of blinking on tear dynamics. METHODS: One eye of 21 subjects was imaged at the same time of day on two consecutive days. Dimensional information of the tear film and of the upper and lower tear menisci during normal and delayed blinking were obtained from OCT images using custom software. Digital camera images were used to measure eyelid length and ocular surface area for tear volume estimation. RESULTS: No significant changes in any measured variable occurred between the two repeat visits. During normal and delayed blinking sessions, the tear film thickness increased significantly after each blink (P < 0.05) and then decreased (P < 0.05) during the open-eye period. For normal blinks, the tear meniscus did not change significantly during blinking or during the open-eye period. Except for upper tear meniscus curvature, all other parameters of tear menisci during delayed blinks were higher than those measured during normal blinks (P < 0.05). For delayed blinks, the lower tear meniscus height decreased after the blink (P < 0.05). Also for delayed blinks, the height and area of both upper and lower tear menisci significantly increased during the open-eye period. The total estimated tear volume on the ocular surface was greater during the delayed blinks (P < 0.01), and most of the volume was located in the lower tear meniscus (P < 0.01). CONCLUSIONS: OCT is a promising tool for studying the impact of blinking on tear dynamics. Tear distribution is dynamically balanced and consistent during normal blinking, but it becomes altered during delayed blinking.

Pediatric keratoprosthesis.

OBJECTIVE: To describe the authors' experience using keratoprosthesis to treat pediatric corneal opacity. DESIGN: Nonrandomized, consecutive, retrospective interventional series. PARTICIPANTS: Twenty-two eyes of 17 children with opaque corneas as a result of primary congenital disease and or previous failed keratoplasty. METHODS: A retrospective review of pediatric patients with a history of corneal opacification treated with keratoprosthesis surgery. MAIN OUTCOME MEASURES: Intraocular pressure, inflammation, clarity of the visual axis, visual acuity, refraction, complications, and retention of the prosthesis. RESULTS: Twenty-two eyes of 17 patients 1.5 to 136 months of age underwent 23 keratoprosthesis procedures. The follow-up period was 220 patient months (range, 1-37 months; mean, 9.7 months). In both cases implanted with the AlphaCor (Argus Biomedical Pty. Ltd., Perth, Australia), the keratoprosthesis was not retained. In one instance, the prosthesis sustained traumatic dislocation and was replaced with a cadaver cornea. In the second instance, the intralamellar implant began to extrude and was replaced with a Boston keratoprosthesis. In all 21 Boston cases, the prosthesis was retained without dislocation or extrusion. The visual axis remained clear in 100% of cases, although retroprosthetic membranes were removed in 5 eyes. Reoperation was necessitated for management of concurrent glaucoma (n = 3) or retinopathy (n = 2). There were no instances of surface infection or endophthalmitis. In 7 instances where patient age was 4 years or more, visual acuity ranged from counting fingers to 20/30. In the remaining cases, all infants were able to follow light, fingers, and objects. Intraocular pressure was controlled in all cases. CONCLUSIONS: Implantation of the Boston keratoprosthesis rapidly establishes and maintains a clear optical pathway and does not prejudice management of concurrent glaucoma or retinopathy. The device is retained without extrusion or rejection and is appropriate for the management of pediatric corneal opacity.

The Boston keratoprosthesis in herpetic keratitis.

OBJECTIVE: To evaluate the role of an artificial cornea (Boston Keratoprosthesis [KPro]) in herpetic corneal graft failures. METHODS: A series of 17 herpetic eyes of 14 patients with failed transplantations, treated with implantation of a corneal graft with a KPro, was reviewed. Outcomes measured were retention of the device, visual acuity at 1 week, best visual acuity, last assessed visual acuity, time of follow-up, and complications. RESULTS: Follow-up ranged between 6 and 72 months (median, 14 months). All patients had improvement in postoperative visual acuity, with 16 (94%) of 17 eyes getting better than preoperative visual acuity within 1 week. Of the 17 eyes, 15 (88%) achieved a best visual acuity of 20/25 to 20/70 and, at the last examination, 11 eyes (73%) were still in that range. Four patients with prolonged preoperative inflammation and ulceration at KPro placement had resolution of inflammation within days. The KPro had no extrusions. Complications included retroprosthesis membrane in 3 eyes and 1 tissue melt in an early case. CONCLUSIONS: The KPro can be of value in patients with graft failure from herpetic keratitis, even in the inflamed stage. We believe that herpetic keratitis is not a contraindication for KPro use.

Histopathologic and immunologic aspects of alphacor artificial corneal failure.

PURPOSE: To describe the histopathologic and immunologic characteristics of late artificial corneal failure in a small series of patients who underwent AlphaCor implantation and to elucidate the mechanisms involved. DESIGN: Clinicopathologic case series. METHODS: Three patients were diagnosed with corneal melting during the late postoperative period and required the removal of the devices. The explanted devices embedded within the corneal tissues were examined by light microscopy, electron microscopy, and immunohistochemical studies. RESULTS: Light microscopic examination of the specimens disclosed adequate biointegration with no foreign body response. Immunofluorescence studies of the skirt exhibited expression of inflammatory cytokines such as interleukin-1beta (IL-1beta) and tumor necrosis factor alpha (TNF-alpha), and some interferon gamma (IFN-gamma). The keratocytes stained positively for Thy-1 and smooth muscle actin but negatively for CD34. CONCLUSIONS: Although these findings confirm the occurrence of biointegration, myofibroblastic differentiation of the ingrowing keratocytes is a prominent feature.

Outcomes of Boston keratoprosthesis in aniridia: a retrospective multicenter study.

PURPOSE: To evaluate the long-term outcomes of keratoprosthesis as an alternative surgical procedure in the management of aniridic keratopathy. DESIGN: Retrospective, multicenter case series. METHODS: Fifteen adult patients (16 eyes) with aniridia who were deemed at high risk for regular donor corneal transplantation underwent a Boston type I keratoprosthesis procedure for visual rehabilitation. Device retention rate, preoperative and postoperative visual acuity, and intraoperative and postoperative complications were studied. RESULTS: The mean age of the patients was 45 (median 50) years. Six of the patients were females. Eleven patients had previously undergone donor corneal transplantations (average two grafts), with failure. In 10 patients, the keratoprosthesis surgery was combined with other procedures such as cataract extraction, tube shunt implantation, vitrectomy, and intraocular lens removal. No intraoperative complications were encountered. The follow-up ranged from two months to 85 months, with a median of 17 months. All devices remained in situ throughout the entire follow-up period. The visual acuity improved in all but one patient from a median of counting fingers (light perception to 20/300) to 20/200 (hand motions to 20/60). Comorbid preoperative conditions particularly optic nerve and foveal hypoplasia limited the final postoperative vision. No endophthalmitis or extrusion of the device occurred. One device required repair procedure without necessitating a removal. CONCLUSIONS: Keratoprosthesis offers significant vision benefits in this patient group.

Management of exposure keratopathy associated with severe craniofacial trauma.

We describe a case of severe craniofacial trauma with resultant exposure keratopathy that was refractive to traditional treatment measures including aggressive lubrication, tarsorrhaphy, platinum lid weight implantation, punctal plugs, correction of lid retraction, amniotic membrane application, and multiple bandage contact lenses. Through combined Boston scleral lens placement and traumatic cataract extraction with intraocular lens (IOL) implantation using scleral lens IOL power calculations, we were able to maximize patient comfort and attain superior visual acuity. To our knowledge, calculation of IOL power through a scleral lens has not been described.

Keratoprosthesis: current techniques.

PURPOSE: To compare and contrast the techniques and results of keratoprosthesis (KPro) using the Cardona device (1975-1985) with those related to the use of the Dohlman-Doane type 1 device (2003-2005). METHODS: We conducted a retrospective review of 31 cases of Cardona KPro implanted between 1975 and 1981 and a review of 25 cases of Dohlman-Doane type 1 KPro implanted between 2003 and 2005. Procedures were limited to eyes with a poor prognosis for traditional penetrating keratoplasty. RESULTS: In the Cardona cases, 39% (12/31) of patients achieved a visual acuity of 20/40 or better at some point postoperatively, degrading to 16% (5/31) at the end of the observation period. Fifty percent (15/31) required subsequent surgical revision of the KPro. Sixteen percent of cases (5/31) developed endophthalmitis, and 58% (18/31) developed retroprosthetic membranes. There were 5 dislocations of the prosthesis and an additional 3 frank extrusions (26%). Of the 25 Dohlman-Doane cases, there have been no reoperations, endophthalmitis, dislocations, or extrusions to date (8/15/05). Forty-eight percent (12/25) achieved 20/200 acuity or better, and 12% (3/25) achieved 20/40 or better. Retroprosthetic membranes formed in 3 cases. CONCLUSION: Although KPro remains a technique to be used in poor prognosis keratoplasty, improvements in the design of the device and surgical technique over the past 30 years have reduced the overall morbidity and severity of complications and improved the prognosis for visual rehabilitation.

Keratoprosthesis in Ectodermal Dysplasia.

PURPOSE: To describe the complex surgical management and novel medical approach for a keratoprosthesis (KPro Boston type I) in a monocular, 73-year-old patient with ectodermal dysplasia and chronic, noninfectious corneal necrosis. METHODS: Best-corrected visual acuity (BCVA) was measured with Snellen letters. Surgical intervention included an amniotic membrane graft, complete replacement of the KPro, conjunctival flap graft, corneal donor tissue grafts combined with inferior rectus muscle advancement, periosteal tissue graft, tarso-conjunctival flap construction, and symblepharolysis. Infliximab was used as a medical adjunctive therapy. RESULTS: Initial KPro placement provided a BCVA of 20/25 and long-term stability. Subsequent chronic melting at the optic border necessitated numerous surgeries to prevent extrusion and failure. Ultimate fistulization was addressed with the formation of a surgical pocket. The addition of infliximab promoted ocular surface stability, and the patient has maintained a BCVA of 20/80. CONCLUSIONS: Ectodermal dysplasia can result in eyelid and corneal abnormalities, requiring a KPro for visual restoration. In the setting of chronic, sterile corneal melt, novel surgical approaches and the off-label use of infliximab allowed for visual rehabilitation.

Protective effect of soft contact lenses after Boston keratoprosthesis.

PURPOSE: To evaluate associations between preoperative diagnosis, soft contact lens (SCL) retention and complications. METHODS: A retrospective chart review was conducted of 92 adult patients (103 eyes) who received a Boston keratoprosthesis type I at the Massachusetts's Eye and Ear Infirmary or the Flaum Eye Institute. Records were reviewed for preoperative diagnosis, SCL retention and subsequent complications. Preoperative categories included 16 autoimmune (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, rheumatoid arthritis and uveitis), 9 chemical injury and 67 'other' (aniridia, postoperative infection, dystrophies, keratopathies) patients. RESULTS: 50% of the lenses had been lost the first time after about a year. A subset (n=17) experienced more than 2 SCL losses per year; this group is comprised of 1 patient with autoimmune diseases, 2 patients with chemical injuries and 14 patients with 'other' diseases. The preoperative diagnosis was not predictive of contact lens retention. However, multivariate analysis demonstrated that the absence of a contact lens was an independent risk factor for postoperative complications, such as corneal melts with or without aqueous humour leak/extrusion and infections. CONCLUSIONS: Presence of a contact lens after Boston keratoprosthesis implantation decreases the risk of postoperative complications; this has been clinically experienced by ophthalmologists, but never before has the benefit of contact lens use in this patient population been statistically documented.