Skip to main content
SpringerLink
Log in

What Is New in Keratoprostheses

  • Chapter
  • First Online:
Modern Keratoplasty

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

  • 132 Accesses

Abstract

Corneal transplant aims to replace opacified, scarred or deformed cornea with cadaveric donor material. However, there are two clinical scenarios when we need to consider bypassing the ocular surface and cornea with a keratoprosthesis to restore sight in corneal blindness. Where there have been multiple graft failures or a heavily vascularised cornea, and in the presence of adequate tear production and perfect blinking mechanism, a Boston Type 1 keratoprosthesis (BKPro1) may be considered instead of high-risk conventional keratoplasty. BKPro1 is a Polymethylmethacrylate (PMMA) and titanium collar stud device that sandwiches a carrier corneal graft button for full-thickness transplantation. Limbal stem cell deficiency is not a problem, but any degree of keratinisation, tarsal or bulbar, will compromise the outcomes. Were the ocular surface is hostile with keratinisation, and in the presence of a defective lid or blink, an osteo-odonto-keratoprosthesis (OOKP) is indicated. The OOKP is an epicorneal device using a lamina created from the patient’s own canine tooth root and surrounding jawbone to carry a PMMA optical cylinder wrapped with an overlying buccal mucous membrane graft. Keratoprostheses are inherently unstable and should not be used when there is a fellow-seeing eye and should not be implanted bilaterally. Although they may be visually devastating, the rate of complications of keratoprostheses has been significantly reduced by improving the design of the devices and the development of prevention and management protocols for the complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gomaa A, Comyn O, Liu C. Keratoprostheses in clinical practice—a review. Clin Exp Ophthalmol. 2010;38:211–24. https://doi.org/10.1111/j.1442-9071.2010.02231.x.

    Article  Google Scholar 

  2. Anshu A, Li L, Htoon HM, de Benito-Llopis L, Shuang LS, Singh MJ, et al. Long-term review of penetrating keratoplasty: a 20-year review in Asian eyes. Am J Ophthalmol. 2020;224:254–66. https://doi.org/10.1016/j.ajo.2020.10.014.

    Article  Google Scholar 

  3. Gain P, Jullienne R, He Z, et al. Global survey of corneal transplantation and eye banking. JAMA Ophthalmol. 2016;134(2):167–73.

    Article  Google Scholar 

  4. Deng SX, Borderie V, Chan CC, et al. And the international Limbal stem cell deficiency working group. Global consensus on definition, classification, diagnosis, and staging of limbal stem cell deficiency. Cornea. 2019;38(3):364–75.

    Article  Google Scholar 

  5. Fernandez-Buenaga R, Aiello F, Zaher SS, et al. Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency. BMJ Open Ophthalmol. 2018;3:e000164. https://doi.org/10.1136/bmjophth-2018-000164.

    Article  Google Scholar 

  6. de Quengsy GP, Des HD. Pellier de Quengsy Sammlung von Aufsätzen und Wahrnehmungen sowohl über die Fehler der Augen, als der Theile, die sie umgeben Junius. Leipzig: Junius; 1789.

    Google Scholar 

  7. Lam FC, Liu C. The future of keratoprostheses (artificial corneae). Br J Ophthalmol. 2011;95:304–5. https://doi.org/10.1136/bjo.2010.188359.

    Article  Google Scholar 

  8. Hille K, Grabner G, Liu C, et al. Standards for modified osteo-odonto-keratoprosthesis (OOKP) surgery according to Strampelli and Falcinelli: the Rome-Vienna protocol. Cornea. 2005;24:895–908.

    Article  Google Scholar 

  9. Avadhanam VS, Smith HE, Liu C. Keratoprostheses for corneal blindness: a review of contemporary devices. Clin Ophthalmol. 2015;9:697–720. Published 2015 Apr 16. https://doi.org/10.2147/OPTH.S27083.

    Article  Google Scholar 

  10. Holland G, Pandit A, Sánchez-Abella L, Haiek A, Loinaz I, Dupin D, Gonzalez M, Larra E, Bidaguren A, Lagali N, Moloney EB, Ritter T. Artificial cornea: past, current, and future directions. Front Med. 2021;8:770780. https://doi.org/10.3389/fmed.2021.770780.

    Article  Google Scholar 

  11. Aldave AJ, Kamal KM, Vo RC, Yu F. The Boston type I keratoprosthesis: improving outcomes and expanding indications. Ophthalmology. 2009;116(4):640–51.

    Article  Google Scholar 

  12. Aldave AJ, Sangwan VS, Basu S, et al. International results with the Boston type I keratoprosthesis. Ophthalmology. 2012;119(8):1530–8.

    Article  Google Scholar 

  13. Chew HF, Ayres BD, Hammersmith KM, et al. Boston keratoprosthesis outcomes and complications. Cornea. 2009;28:989–96.

    Article  Google Scholar 

  14. Zerbe BL, Belin MW, Ciolino JB. Boston type 1 keratoprosthesis study group results from the multicenter Boston type 1 keratoprosthesis study. Ophthalmology. 2006;113:1779–84.

    Article  Google Scholar 

  15. Stacy RC, Jakobiec FA, Michaud NA, Dohlman CH, Colby KA. Characterization of retrokeratoprosthetic membranes in the Boston type 1 keratoprosthesis. Arch Ophthalmol. 2011;129(3):310–6.

    Article  Google Scholar 

  16. Magalhães FP, Sousa LB, Oliveira LA. Boston type I keratoprosthesis: review. Arq Bras Oftalmol. 2012;75(3):218–22.

    Article  Google Scholar 

  17. Kamyar R, Weizer JS, de Paula FH, et al. Glaucoma associated with Boston type I keratoprosthesis. Cornea. 2012;31(2):134–9.

    Article  Google Scholar 

  18. Banitt M. Evaluation and management of glaucoma after keratoprosthesis. Curr Opin Ophthalmol. 2011;22:133–6.

    Article  Google Scholar 

  19. Li JY, Greiner MA, Brandt MC, Lim MC, Mannis MJ. Long-term complications associated with glaucoma drainage devices and Boston keratoprosthesis. Am J Ophthalmol. 2011;152(2):209–18.

    Article  Google Scholar 

  20. Rivier D, Paula JS, Kim E, Dohlman CH, Grosskreutz CL. Glaucoma and keratoprosthesis surgery: role of adjunctive cyclophotocoagulation. J Glaucoma. 2009;18:321–4.

    Article  Google Scholar 

  21. Robert MC, Moussally K, Harissi-Dagher M. Review of endophthalmitis following Boston keratoprosthesis type 1. Br J Ophthalmol. 2012;96(6):776–80.

    Article  Google Scholar 

  22. Nouri M, Terada H, Alfonso EC, Foster CS, Durand ML, Dohlman CH. Endophthalmitis after keratoprosthesis: incidence, bacterial causes, and risk factors. Arch Ophthalmol. 2001;119(4):484–9.

    Article  CAS  Google Scholar 

  23. Durand ML, Dohlman CH. Successful prevention of bacterial endophthalmitis in eyes with the Boston keratoprosthesis. Cornea. 2009;28(8):896–901.

    Article  Google Scholar 

  24. Boston KPro News. Fall. 2011. 8. Accessed 23 Jan 2013. www.masseyeandear.org.

  25. Basu S, Nagpal R, Serna-Ojeda JC, Bhalekar S, Bagga B, Sangwan V. LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness. Br J Ophthalmol. 2018. pii: bjophthalmol-2017-311649.

    Google Scholar 

  26. Mehran Z-G, Liu C. Keratoprosthesis: current choices and future development. Asia Pac J Ophthalmol. 2019;8(6):429–31. https://doi.org/10.1097/APO.0000000000000268.

    Article  Google Scholar 

  27. Strampelli B. Keratoprosthesis with osteodontal tissue. Am J Ophthalmol. 1963;89:1029–39.

    Google Scholar 

  28. Falcinelli GC. Personal changes and innovations in Strampelli's osteo-odonto-keratoprosthesis. An Inst Barraquer. 1998;28:47–8.

    Google Scholar 

  29. Tan A, Tan DT, Tan X-W, Mehta JS, Keratoprosthesis O-o. Systematic review of surgical outcomes and complication rates. Ocul Surf. 2012;10(1):15–25.

    Article  Google Scholar 

  30. Michael R, Charoenrook V, de la Paz MF, Hitzl W, Temprano J, Barraquer RI. Long-term functional and anatomical results of osteo- and osteoodonto-keratoprosthesis. Graefes Arch Clin Exp Ophthalmol. 2008;246:1133–7. https://doi.org/10.1007/s00417-008-0850-3.

    Article  Google Scholar 

  31. Zarei-Ghanavati M, Avadhanam V, Vasquez Perez A, Liu C. The osteo-odonto-keratoprosthesis. Curr Opin Ophthalmol. 2017;28:397–402.

    Article  Google Scholar 

  32. Tan A, Tan DT, Tan XW, Mehta JS. Osteo-odonto keratoprosthesis: systematic review of surgical outcomes and complication rates. Ocul Surf. 2012;10:15–25. https://doi.org/10.1016/j.jtos.2012.01.003.

    Article  Google Scholar 

  33. Liu C, Okera S, Tandon R, Herold J, Hull C, Thorp S. Visual rehabilitation in end-stage inflammatory ocular surface disease with the osteo-odontokeratoprosthesis: results from the UK. Br J Ophthalmol. 2008;92:1211–7. https://doi.org/10.1136/bjo.2007.130567.

    Article  CAS  Google Scholar 

  34. Marchi V, Ricci R, Pecorella I, Ciardi A, Di Tondo U, Osteo-odonto-keratoprosthesis. Description of surgical technique with results in 85 patients. Cornea. 1994;13:125–30.

    Article  CAS  Google Scholar 

  35. Avadhanam VS, Vasquez-Perez A, Chervenkoff JV, El-Zahab S, Liu C. Mucosal complications in osteo-odonto keratoprosthesis (OOKP) surgery. J EuCornea. 2020;6:13–23. https://doi.org/10.1016/j.xjec.2020.01.001.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sussex Eye Hospital, Brighton, UK

    Saif Bani Oraba

  2. Ibra Hospital, Ibra, Sultanate of Oman

    Saif Bani Oraba

  3. Brighton and Sussex Medical School, Brighton, UK

    Christopher Liu

  4. Brighton and Tongdean Eye Clinic, Sussex Eye Hospital, Hove, UK

    Christopher Liu

Authors
  1. Saif Bani Oraba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Vissum Miranza, Miguel Hernández University, Alicante, Spain

    Jorge L. Alió

  2. Vissum-Instituto Oftalmologico de Alica, Miguel Hernandez University, Alicante, Alicante, Spain

    Jorge L. Alió del Barrio

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bani Oraba, S., Liu, C. (2023). What Is New in Keratoprostheses. In: Alió, J.L., del Barrio, J.L.A. (eds) Modern Keratoplasty. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-32408-6_37

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-32408-6_37

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-32407-9

  • Online ISBN: 978-3-031-32408-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation