Keratoprosthesis: A Review of Recent Advances in the Field

Abstract

Since its discovery in the years of the French Revolution, the field of keratoprostheses has evolved significantly. However, the path towards its present state has not always been an easy one. Initially discarded for its devastating complications, the introduction of new materials and the discovery of antibiotics in the last century gave new life to the field. Since then, the use of keratoprostheses for severe ocular surface disorders and corneal opacities has increased significantly, to the point that it has become a standard procedure for corneal specialists worldwide. Although the rate of complications has significantly been reduced, these can impede the long-term success, since some of them can be visually devastating. In an attempt to overcome these complications, researchers in the field have been recently working on improving the design of the currently available devices, by introducing the use of new materials that are more biocompatible with the eye. Here we present an update on the most recent research in the field.

Alternatives to eye bank native tissue for corneal stromal replacement

“…For a more comprehensive review of KPros and artificial corneas, a number of book chapters as well as books are available (Barber, 2011;Cortina and de la Cruz, 2015;Dohlman et al, 2014;Salvador-Culla and Kolovou, 2016;Tan et al, 2012a).…”

Optimization of spark plasma sintered titania for potential application as a keratoprosthesis skirt

“…Many corneal diseases are treatable by donor tissue transplantation (penetrating keratoplasty, lamellar keratoplasty or endothelial keratoplasty), but the success is restricted by a myriad of factors including global donor shortage and allogeneic graft rejection . An alternative to allografts is an “artificial cornea” or its equivalent term “corneal prostheses” or “keratoprotheses (KPro's)” . The classical KPro's are ‘core‐skirt’ designed plastic‐based materials.…”

“…It was approved by US FDA in 1992 and CE‐marked in 2014. Since its inception at the Massachusetts Eye and Ear Infirmary in 1960s, 12,000 B‐KPro have been implanted . Both Type I and II designs are made of an anterior plate of pure PMMA (polymethyl methacrylate) with a central optical stem cylinder for efficient light passage and titanium back plate with a donor cornea sandwiched between the two plates.…”

Three-Dimensional Construction of a Rabbit Anterior Corneal Replacement for Lamellar Keratoplasty

“…The situation has become increasingly serious due to the increasing use of corneal laser vision corrective surgery and increase in the incidence of transmissible diseases such as HIV and hepatitis [7–9]. To solve this problem, several groups have tried to develop corneal substitutes such as tissue engineering cornea (which is very prevalent today) [10–16] and keratoprostheses [17, 18]. Presently, several types of keratoprostheses have been used in the clinic.…”

“…Presently, several types of keratoprostheses have been used in the clinic. However, they still have serious complications, including retroprosthetic membrane formation, neovascularization, infection and glaucoma [17]. Therefore, their use was limited in the clinic.…”