The effects of Medroxyprogesterone in corneal melting after Boston Type keratoprosthesis implantation

The aim of this paper was to assess efficacy of topical medroxyprogesterone (MPG) in melting therapy after Boston type I K Pro implantation. A 73-year-old male patient with full corneal opacity in both eyes underwent a Boston K Pro implantation in the right eye followed by corneal melting reaction. Corneal melting was clinically documented by slit lamp digital photography (C.S.O, Digital Vision, Florence, Italy) and anterior chamber OCT (Visante™ Zeiss Meditech, Jena, Germany). In order to halt melting progression and preventing K Pro extrusion, medroxyprogesterone (MPG) acetate drops (Depo-Provera™, Pharmacia & Upjohn, Kalamazoo, MI, USA. 150 mg/mL injection) were prepared under clean conditions by diluting 1 mL of (MPG) to 15 mL with normal saline. Between 1 and 2 mL of the suspension was introduced into 15-mL sterile plastic eye drop bottles. One month after treatment the stop of melting progression was clinically documented. The Visante OCT™ examination performed three and six months after the treatment documented a stabilization of corneal thinning associated with a slight corneal thickening. Medroxyprogesterone (MPG) medical therapy may have a protective effect with regard to melt onset and severity due to its anti-collagenase activity. Controlled studies would assist evaluation of the use of medroxyprogesterone in melting prevention after Boston type I K Pro implantation.